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<br /> CITY OF EVERETT--Water Dept.
<br /> Applica4ion No.....:�..Y..��',... Date..........�_:_..i:._S,rt_..J...���...19',��
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<br /> On ............._::....._`•--...{.....l.._:'...;::'._�.._':...................................... Street
<br /> Lot.............................................................. Block No............._.....................--
<br /> Addition ...-�--�................................................................................................
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<br /> � L/ll20R ANL DiATERIAL IISED
<br /> � 'No. Size �
<br /> ..... ....... . ...__....:................I Lead Connection Complete
<br /> .............: .._............................... �addle Complete
<br /> ..............:.�.(.'.St....._i:.__............... .._�..�..1�:);.•.�................_...............................Pipe
<br /> ...................�.............:.:_.............. Sernce Cock
<br /> ...._.................L..................... Service Dox
<br /> No. Hours Labor..............................................Cost..................................................--
<br /> Cutin....................Pavement....................X......._............... ........................Sq.Ft.
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<br /> -- Total ........................Sq.Ft.
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<br /> RemarIcs................................._(c..__!:�.i..x.....:'�:...b.:......:.1... '. . ,`..............
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<br /> OrderPeceived.._........._..__.................................................
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<br /> \Vork Campleled...:.......::...:.:..... �,
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<br /> Foreman
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