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zs88 ` °�� <br />R�.1. PNI[�1T,� .+ "J� �1�. ./� ..) V !� <br />�. �. �p� i�ITY OF �EVERETT�Water Dept. <br />A lication No ....................1.' D�te_......_;:?.'_`_I'::.:::i....'Ji......:...1Pr�I <br />�c� � � .... <br />PP ' <br />lnstall.........r. �t!•.•...-.-��� .lnch water service ipe <br />� �„ � iT� <br />..... <br />............................. .................... . . . <br />FoC...............................................1..... _r . <br />� �- ----" r' / i , . � <br />�T'__ .. .::.... .:... :........ ... .:..:.............�..:............... Street <br />l7n .........�._:z_ . . <br />Lot............_'......C......_..I_r`�< ................ Block No...._�_'.!.......................-- <br />� ti� .......... . .. ...�-' -- <br />) '� �_.d...:.: � ..........:.... <br />Addition """""' <br />. . .. <br />..................... . <br />,. . � <br />� ...'F �/ �\ t r. <� rl <br />� <br />,�:.,..a ...........................----- . <br />:a '� n 1) .� 4...�.J......i:..su�.. ' <br />., <br />. .. ..............:1 ............................... rinf <br />...... `.. r� --. ,�,.. � _ S� i � <br />V a� . ; r <br />LABOR AND MA7'EBiw ti�� <br />........................ <br />:.ead Conneation Complete <br />Saddle Complete <br />__....._- . <br />Scrvice Cock <br />Service Box <br />� <br />. <br />No. Hours a o .....................................X.._.................... ........................S9.Ft. <br />Cut in ....................Pavement.........._ . .� <br />....... _ ............... <br />. , .................... ........................ �� <br />. . . ........................ �� <br />. ....................X........................ <br />Y�% ....................X..._.....___........ ._.................... <br />Total .................._....Sq. Ft. <br />---" %i <br />_ _— � „ <br />. . ................. <br />._. •�...:..� ..............._., ., <br />; � t .:.............. <br />Remarks............................................ • � <br />� . .. . / . ..._.._..,:._ ............. <br />................................................ <br />�......:..:. ._.. <br />.. �, <br />i <br />1J....... J....4h..:.... ... .......................................... <br />. ............................ ....................... <br />OrderRecei��ed .....................................................................:....................... <br />�- , <br />/ ;-..., <br />.................... .... �......_... �. .. <br />�....� :...:..........._ . Foreman <br />Nork Completed...,......L.:....:.. <br />