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3r <br />` � I%D� ' �-.Sl� � <br />W� D. IOAM ] <br />CITY OF EVERETT--Water Dept. <br />/7 o G C ..........................19...... <br />Application No ........................ Date...................... <br />I�stall .............................inch water service pipe <br />For..................... ........�................7....................... -- <br />a?. �j f�. �.c� [.C.�_"a-�-� ..................................... Street <br />On.................................................................. <br />- --... Block No ..............-..................... <br />Adilition................................................................. <br />Remarks...................................................... <br />i <br />...................... ...................... <br />No. <br />........ 4 ( <br />....�... _' ............................. <br />t -L1.. <br />.. ..... <br />�....: ...... ........... ... . ... . . <br />........ .. <br />.�J . Superinten en <br />_:`%�C-�l_ct��, _ <br />LABOA AND MATERIAL <br />Lead Connection ComP�eti <br />Snddlc Comple:c <br />...................._ . <br />Scrvice Cocl. <br />Scr�ice Bo:< <br />..................... ... <br />..........................I .......... .....� <br />..... .............. ........... <br />............__. <br />....Cost ......................................... .......... <br />No. Hours Lsbor .......................................... ' <br />........................54. Ft. <br />Git in ................_.Pavemcnt.................._X......................_ �� <br />........................ <br />.................... ........................ ,� <br />....................X........................ ........................ <br />....................X........................ <br />........................ �� <br />Total ........................Sq. Ft. <br />----- <br />-------- -- <br />-- Remarks ............................................................................................................ <br />- - ............. <br />.......................................................................... <br />....................................................................................... <br />OrderReceived ......................................... ..........................._... _.............. <br />\Vork Completed .. ............................................_........................Foreman <br />