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'w.D.Fo:m3 imos.t.m <br />CITY OF EVERETT... Water Dept. <br />Application No.---.._J Petc„ / y_-.-_l9 <br />2-1 <br />n - , <br />Install in: h water service pipe <br />For <br />On.R-.'ti.. �U—tt,�..'�`.i%..-2,-_r_—-�'u.. _..---..Street <br />I_or _ __. _. Block No. <br />Addition �t <br />Remarks <br />-_t G <br />LABOR AND MATERIAL USED <br />No <br />Six <br />; rOt <br />Lead Connection Complete <br />/ A C <br />Sad Ic Complete <br />Pipe <br />_... <br />Service Cock ' <br />sa=:.e-Finn <br />p � <br />i <br />i _. <br />Cut in .. __......_ _. _. <br />1'avcmcnt.l F.d."%.F.�X ..._.__.. ....... ......_...... ....... _Sq. Ft. <br />X " <br />- <br />x ..... ... __... ...... .. <br />X.... .. <br />Total <br />Remarks Giaterial SUP-23o._cf �'�`S 7G�_ . __........._._—. <br />.�:.:::....___— <br />Ordet Receive <br />%Nlotk Completed ._ ..._( -' ........ .. <br />Funmm p %- <br />