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� � /�3� )r, <br />w. U. f:1RM 0 � •~' � I/ L�..� /- / <br />_4 iITY OF EVERETT--Water Dept. <br />._'�'_� K,�R 1 7�' <br />f;�QiiFa�ion No. � • � . ....................1f�...... <br />,. :�...t..�. �.. Date ................... .:''. <br />� . <br />__ Tnstal]_ ... ....................... .im:h water service pipe <br />'. .:: �,�i-:- t <br />'. � c �. . . f : ' <br />F �r ' � _ .............. ._.............................. <br />- . ................ ......_._.........._...._ -........... <br />i , , -� � � � .., .�. a � <br />On � . ' . , c . <br />�.�../.�.,! :...... .....:_!..:.._...�.,..�.._,..'.,......................................_ ...tre�.t <br />i <br />LoL.._........._........._.....-- ...................... Block *to.................................... <br />Acidilion..................................................................................................... <br />Remarkc............. ........_..............._..._...._ _................. _...................__..... <br />............._..... <br />_ .......... ..... _. <br />.............._......_ ................. ... - .._......... - ---- <br />Superintendent <br />LABOR AND MATERIAL USED <br />No. j Sixe <br />_._--� .___—. <br />__ <br />......._.. ....................._._.... :.cad Connection Complefe <br />.................�....._............._._.. Saddle Complete <br />._.........fl ......................__.. _._.. ...._......................._..............................PiPe <br />...................._..............._.... Scrvice Cor.k <br />................ ......................._. Scrvice Box <br />No. f{ours L36or ..............................................Co�t.................................................... <br />Cutia ...................Faven•�cnl.................._X._..................... ........................Sq. Ft. <br />....................X........................ �� <br />........................ <br />.... ...............X..___................. .� <br />........................ <br />....................X........................ �� <br />........................ <br />9btal ........................Sq. Ft. <br />._ _ _—� . _— __--_____ __ <br />R�marks ............................................._........ ........._....____............. ................ <br />................................................................................................................ ... <br />OrderReceiced._ ..................................._............................_........._~., ... <br />\Vork Cnmplcted ................................................................_.........___... `. <br />Foreman� <br />