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S1.�rieLeiM]-167/.?�!J _ I Q . ; .- �,�, � � . <br /> W.D.Form J ( �� ..• %3: ' � � <br /> <�ITY OF EVERETT--Water Dept. ; , <br /> � � c � � ;. ' , .� � j <br /> .lpplicatlon No.............:.......... Date...�:.....::............:...................19.._.. � <br /> Install.....:?/...:�........._......inch water service pipe <br /> For ..................:.......................�. ...............__....................:............................ <br /> ._ . �__ ,, <br /> On ......_..:..::........ �........_il.. ... -.......:....'...............':_!.:....�"_..... Strect <br /> Lot......................................................�...... Block No.................................--•- <br /> Addi;iun ._.C......:'..:....:. ::. <br /> . ...........:.................................................................. <br /> Remarks ...._�................................................ <br /> ....... ..................................... <br /> ........................ ............................................................................................... <br /> . <br /> 1 �................................................................................................ <br /> �� ,..,...../............ <br /> , . �:t': i.�:+_�� (. T�-.� ......... ................. ....�1......5_•rinten........... <br /> L... _ <br /> ....... <br /> St � , . , <br /> . . ............ <br /> .... = <br /> n �� ye dent . <br /> � � . .� , . . / . . . . "'`_� <br /> ��. ----.--- - <br /> � .. � LABOR AND 1NATERIAL USED ,�� <br /> No. ' Size <br /> __--_—.... . .. _._—_- —_. ._—__ p _-- <br /> ............ . <br /> ... '� .� � �^a �onneclion Com lete <br /> ............................_......................�� Saddle Completc <br /> .......................'t.l........_.._............ ........................................._...._....................._Pipe <br /> ................._...._.I_......................... Scrvicc Cock <br /> ..................__.............................._ Sm•v:cc Box <br /> Na. Hours Labor........_........._......__..__.........Cosl..........................._....................... <br /> Cutin............_....Pavement....................X.............._..__.. .........._............Sq.Ft. <br /> ....................X........................ �, <br /> ........................� <br /> ....................�.............._........ .� <br /> .......------........ <br /> ..._........__...k........................ .� <br /> ........................ <br /> Total .......................59.Ft. <br /> :- ___—_._—___ . ____ .__.._ _.__—_._—-- <br /> Rcrnarks. ...�..:.: ........:.:..:...._........_...... :....._.......:.......__._ � <br /> ............................ / <br /> _ .... _.................................. ... ....................._......._..._............_................. <br /> .......................................................................................................... <br /> O:dcr ;cccic�d.._..........._........_....................._............................_.......:....... <br /> \1'ork Comp!e[ed.........:...L_:.::.......1�...:i. ..............................: <br /> ..... <br /> � " I' eman <br />