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<br /> -CITY OF _EVERETT--Water Dept.
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<br /> Application No.l....'°.'...._......j--. Date.... .....::::...........::'...�..........19::-•'"
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<br /> IrutalL...:'..::�:�................inch water service pipe
<br /> . ....
<br /> For ...........................................................................:._................._---..... ..
<br /> On .....................e�..`,l-�•-...�'�.-.... ..._....1-r-.--?;��.:--�---................... Street
<br /> Lot.............................................................. Block No........._.................._........
<br /> Addition ... .............................................................................................. ,
<br /> .........
<br /> / �,,.,'...........................
<br /> i F.emarks ._✓:.-....::�......--•.............................:..........
<br /> r _���_ir'.�J.',F'. ....�.:..'_.._.._`f......,..4........_,.(..I.�-_.....----.._.........
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<br /> �......�._ ..........._,.;........ t i�l f�rv� r�_,
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<br /> .................................................... f SuPerintendent
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<br /> LABOii AND MATERIAL D9ED
<br /> No. Size �--
<br /> ..............................
<br /> .__................. :.ead Connection CcmP�ele
<br /> .....................
<br /> ................... 3addlr Complete
<br /> ............... . . � n; ,. ....................Pipe
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<br /> . ..........................
<br /> ...........i-�.....::.St........:..:¢.............. .......................
<br /> ............
<br /> ......................................... Service Cock
<br />� ,....... Service Box
<br /> ........................... .......................... .........................................................................
<br /> ...............................
<br /> i
<br /> No. Hours Labor..............................................Cost......................---.._.......................
<br /> . .......................5 Ft.
<br /> Cut in....................Pavement....................X......._............... . 4��
<br /> ...................X........................ ......._....--'-'--....
<br /> ....................X........................ ........................
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<br /> ....................X........................
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<br /> Tota] ........................Sq.Ft.
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<br /> ..,t...._:!.'�1.E.:C...._.:.............:.....i...:..:.1-'-'-"-.........
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<br /> Order P�eceived........................._-..-..�....�.._.....................................................
<br /> r e \ i`:l..i�:t,LL:7:LL/Le--..........
<br /> �Vork Completed.,�/���i-_�..................:�. Foreman
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