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W. 1 7roo <br />- D Form <br />5.7. <br />CITY OF EVERETT--Water Dept. <br />ApplicationNof,6 7�Q.. Date <br />N <br />//��,... _. inch Water service pipe <br />For Z J�1 • !/. l`t�_41/�(�P:CYY: Y '• ?tY <br />Lot _ '1/1 � Block No ........ <br />yL ...... <br />Addition - ----- •. -- <br />Remarks ......... fitt4- <br />. <br />LABOR AND MATERIAL USED <br />No. Size_ <br />Lend Connection Complete <br />.._. _.... ....... ..... ._o-_---- Sn`�S�le C�pmplete <br />_.. (t .� _______:al_-P_-Y_�f..:............_._....._...-_.Pipe <br />---___-- -,•_-, ......... ----- Service Cock <br />--------------- , <br />_____________ __ Service Box <br />~___ ..............__. _......__ - <br />No. Hours Labor .............. ....__. C�._ IA:.2.7._. <br />- <br />_.-....__. <br />Cut in ------------ Pavement ..._.___.__ X .............. ........ ..._. Sq. Ft. <br />._._.......- X.............. .� <br />:�. ............X .-.---------- ----------- _. .. <br />Jr L ' / <br />Totnl ---------------Sq. R. <br />Remarks------------------------------- --------- ------------ <br />Order Received----------------------- ------- ----------- ---- <br />Work Completed ------------- ------------ / <br />rona,un <br />, <br />