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CITY OF EVE"RETT—Water Dept. <br />,I <br />Application No...... Date ................. <br />Install ..............................inch water service pipe <br />For......................... <br />. ............................................................ <br />On ..... .... ... 1---1 ....... ......k. U.e.............. Street <br />Lot.... ................... ............................... _.. Block No........_........................... <br />Addition ......... <br />Remarks ........... <br />Superintendent <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Snddlc Complete <br />....... ............. . .................................. 'Pipe <br />Service Cock <br />Service Box <br />............................. I .......................... ........................... ........... - ........... <br />............. I ................... ................... ......................................... . ....... ...... . ..... <br />Order Received...... ...................... <br />WorkCompleted.............................................. . ..... ................... <br />Foremen <br />