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w. o. roar+ o <br />CITY OF EVERETT--Water Dept. <br />Application No ...............A.......... Date ............. P.LQ-A...._N.............19...... <br />^ in <br />stall ..........................inch water service pipe <br />For ...I.../..�sSlt/�`�........ .......... <br />On. ) .�...?'..........................................._......................... Street <br />i <br />Lot.......................... S/ .............. Block No ................. .......... ......... <br />Addition.......................................................................................................... <br />Remarks.......................................................................................................... <br />Size <br />--- --- Superintendent <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />Service Cock <br />Service Box <br />No. Hours Laeor..................................... ......... .•.,,u.......... _.._................................... <br />Cutin ............... .....Pavement...................X....... _............... ........................Sq. Ft. <br />................... X........... _........... rr <br />iZcL/ ......................_...x..................... ..x......................... <br />Total ........................Sq. Ft. <br />OrderReceived............................................................................................ <br />NorkCompleted..........................................................................Foreman <br />