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a a.�,.K ,� �.,2 I t 6 ��� ��_ <br />M. O. IORM � <br />C TY OF E��ER.ETT--Water Dept. r_�� <br />ApplicationNo.�c`.�.�..�_,Dat�: -....�:.....'..<.i:~..:.'-----.19....._ ,i <br />,, Install......:1.y. ��I...�.........�inch riater service piFe <br />Fcr .........�)..�t:Iz_!i`t..�..._r..�::.:..b;��.�!: U...... --� .......... .... <br />..... <br />� : =_. ` — <br />� C7........:..i..... 1../_.�-:�:c..r..:.c ::c� !:r..�. Street <br />On .....^ .................. <br />Addition <br />Remarics <br />:: ----1--- ..L_ �:.�._......_....... Block <br />� <br />.fr_. :..1.. �'..�. ........................... <br />r� � � �, �'' � 1 <br />f � ....:.. ... .. . ........ . ..... ....::.... :_:....... <br />..... .T_..... t <br />d'.'_�' <br />' 1 i (� i <br />p Z� / <br />n `l 1 C <br />, ..�� • LABOR AND MATEBLIL IISF.D <br />....Sr : ..... ..... . . Lead Connectton Complete <br />.. ... ......_ <br />::.............. ...:.............. Saddle Complete <br />Serb`icc Cock <br />Servicc Aox <br />No. Haurs I.abor ..............................................Cost.................................................... <br />Cutin ....................Pavemenl....................X......._............... ........................Sq.Ft. <br />. . �� <br />�,; n ,� . � .................... ..........._........... ......._............... <br />�,�,:,.�� � ._ ................X........................ ........................ ., <br />....................X........................ �� <br />........................ <br />Total .......................Sq. Ft. <br />OrderPeceived.. _ ..................................................................................`...... <br />lvork Completed....7.r...�1..F.::.:;: Sc ..................._....:,�J...4.t �.;,. ta:�:.....\.. <br />Fareman \ <br />, <br />