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W. Dom'.,,, 0 1500 0.1-17 C. P. <br />CITY'OF EVERETT==VNater Dept. <br />Application No.Date ------ <br />I Install __/�f__. _ inch water service pipe <br />d <br />On --- ----�4 — - Street <br />Lot .--------------------- Block No.----- �------- <br />Addition ---- 2P_N 2P_NP_A_k ------------------------------------ <br />Remarks----- -- -------------------------------- ---------- <br />---------------------- ------------------ -- -----�----�-'--- [P----- <br />b;tptlrintendent <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Sul dley��'nntplele <br />_--fd-t__ L% '. _.. ----------- .pipe <br />Service Cock <br />Service Bore <br />No. hours Lalwr.---- ;9�_-_-- __-Cost ---- ��_________________ <br />Cuts Pavement --- _--- ...X-------------- ___-_-..-.Sq. Ft. <br />--------- <br />a------------ .. •, <br />_X-___....__.__ �• <br />Total, ....-------- Sq. Ft. <br />Remarks----------------------------------------------------- <br />----------------------------------------------------------------- ------ <br />Order Received __ <br />-- ------------- ---- <br />Mork Completed --------------- ------ ------------- For- -----/ <br />Foreman <br />