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! ��+ � � ' � /T <br /> 9. n.PR1EBLa'M .,.j '•. ���J <br /> W. U. �ORM ,1 " <br /> CITY OF EVERETT--Water Dept. <br /> / 'd�P � `" - ^�i�� <br /> Application No.....^.:.1...:.� - �Date........:............��...............19...... <br /> 77sta11.....':�!�._���,......inch water service pipe <br /> ,7� � <br /> �J ,�> i '^ �� -{ � ��'��� '� <br /> Far ..................�G.:.....:.�i .......��_--.....-.:.......,�,.....�........................-----... <br /> i . <br /> . , _ <br /> / - �J- � i <br /> On ... ../.....(-....- ......._ :.._ :��............ ........1.:....._....._............... Street <br /> i.ot_........._-• � - _.....--�................... . Block No._--............................_-- <br /> ^�:di[ion ... . �9 f <br /> ...�.C�:i._.�t...!.0.................----.......................................... <br /> ! <br /> ?�.emarks .................� ................................................................................. <br /> ..._........: ....,_... ... . .........q .-....�F� ..._............................._........... <br /> � • , �:�� <br /> ., . <br /> � ....... . ........................._..... ......................... -...---....---......... <br /> �.�_.->..-- s !^d... <br /> ,� . ,-_ <br /> � , . <br /> ^- ..__._._.. 15. ._..�..1 ..t,::1..............."'"__. """ .� J � -� r !. <br /> t�,r.Y .� . ..._...t..r......r-- <br /> ........ <br /> _r....�...:... ::x:-��.. .1..'.....:..-� .....�..... ..,� ::�._.:...... <br /> / �1 t Ac�4'�. . ��...5:�'.ec' ndent <br /> . <br /> � LABOA A1VD MATERIAL USED <br /> No. i Size <br /> -------- ------ <br /> ........................._�........._................i Lead Ccnnection Complete <br /> ......................................................� :addlc Complete <br /> ...... ........:�'_...ft.. -r.°Cr.:............... ._...._......_......--......_............_.......................Pipe <br /> ..... <br /> ................._...1......�i._`:......_....... �mvice Cock <br /> ....__........................... _.....,......... Scrvice Box <br /> No. Iiour; L�Uor..............................................Cost.................................................... <br /> Cutin.................._Pavement........__........X........................ ........................Sq.Ft. <br /> . <br /> . . .. -..: ....................X........................ ......................_ �, <br /> ...................X........................ ,� <br /> ........................ <br /> ....................X........................ ........................ �� <br /> Total ........................Sq.Ft. <br /> ---�---'-------.._------- � --- --� <br /> P�emar;cs.._........... ' <br /> �. .: �' <br /> .......... -;:....._..........:................._........................ <br /> , <br /> , <br /> ___._..._.........'. <br /> ....^..�:._...,..�:.�..:......_...::....�:...t.- ....... ...... <br /> ..._.......................................--.:�.:......e.:.:..:__.�........................_........-•--��----......... <br /> prde: i',eccice�9.............._._........_....... � .................... .. ......_................_. <br /> r _, . . - �; <br /> \io�l: Cmnple:eri.::i.:..:-=.:.':...�.�:G........_.......,....%.L.."L_z.�_.�:�r......... ....._ <br /> Foreman <br />