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5 1 Priebe�M l.(GT�Sy J� / • • <br />W. 1�. Fo'm ] � � ' <br />CITY OF EVER.ETT--Water Dept. <br />�_-`� % � - ,--- . , r <br />Application No ...........:...`..";.'... Date....................-'...._!..._:..........19:.�f.. <br />Install ..............�:��.....inch water service pipe <br />For................................. ................... <br />�' p .� <br />On.......................:...:......._..................:..: <br />Lo t ............................................................ <br />Addition............................................... <br />Remarlcs ..::..................................... <br />_...._._......._ ........................ <br />...:...:...:.::.:..':......:........... Street <br />BlockNo.. • ................................. <br />-- .................................................. <br />_........... _ ..................�----.................. <br />Superintendent <br />LABPR AND MATERIAL USED <br />– - No._� Size – --- — <br />........................._...._---......._..... I Lcad Connection Complete <br />..._ ............................................... �addle Complefe <br />.......................ft.........................._ I ...._...................._................._.........................Pipe <br />_............_ .............._..............__... Scrvicc Cock <br />...................._.._.........._..........._....I Service Box <br />Vo. Hours Labor .............._....._._....................Cosl....._............................................_�-- - <br />Cutin._......_..... Pavement..._....._........X ........................ ........................59.Ft. <br />....................X........................ .� <br />........................ <br />.._ ...............X........................ „ <br />........................ <br />..__..._.........X....._ ..............._ �� <br />.. ..................... <br />Total ............_..._.....Sq. Ft. <br />� ------ —�---- <br />---- <br />Remarks..............._.....:................:.....�.................. ... _....:............._............... ... <br />_ ...__.._....._ _ ............................................ <br />Order Iteceiced..__ .................................. <br />�Cm k Cnm�•leted.,..._...._...,...._ .............. <br />..................................... <br />.... ............... <br />Foreman <br />