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/gl�co� � <br />w• C� ronr+ i <br />��/�� / <br />CITY OF EVERETT--Water Dept. <br />`z°�� , ... ,..i �>z <br />�pplicntion-No../�_�_5...� Date...._ ..........................................19...... <br />For . �Cl..�........4�.�:.t.. _� �� atter service pipe <br />.�........ nsta ....... <br />/� �• C . - <br />.................... <br />�-- ,� � _ <br />On......��...1....� ......................�L................................................ Street <br />Lot.............................................................. Block No..................................... <br />Addition......................................................................................................... <br />I'.emarks .......................................................................................................... <br />............................................. ................................................................................ <br />Superintendent <br />1.ABOR AND MATERIAL USED <br />No. I Sizc ( <br />.............. I .T.cad Connection Complete <br />....................i Sodcllc Complete <br />_ .................. I .. _ _ _....... _ _............................ _.......................Pinc <br />...................� Setvicc Cock <br />................... Scrvicc Box <br />No. Hoars Labor._......__ .................................Cost.................................................... <br />Cutiu......_......._...Pavcrmnt ....................X................._.... ......................_Sq.Ft. <br />....................X........................ �� <br />....... _ ............... <br />....................X........................ �� <br />........................ <br />_ .................X................._..._ �� <br />. ........................ <br />Total ........................Sq. Ft. <br />_ —_ —____—____—________ <br />-- .—_ <br />Remarics...____ ........................_........._.................................... ........._............. <br />........ .................. _.._....... <br />Order Receiced..._..... <br />\Vnrk Campicted..... <br />.... ................... <br />i <br />........_......__. _. <br />Fn:eman <br />