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t",,l t3 , <br />W- O. rORM 3 G <br />CITY OF EVERETT--Water Dept. ` <br />ry/ � <br />/ 7 t Application No:'/.....�Z..�ate....l...l-:_...cam .......... <br />7j <br />Install......-.Y................. .inch water service pipe { ,' <br />Lot..................._......_..._.........._....... ....... Block No .................... .._........... t ' <br />Addition............. _.... ....................... _.......................................................... ... <br />remarks..._._..............._......_._......_.._......_......_......-------...._.---.-------------. 1 3 <br />_....o......_/./.._._.'......------------ <br />------- - <br />.:.�..............,,.... . 'Superintendent <br />A OR A D MATERIAL USED <br />No. _ I Size I _ <br />Lead Connection Complete <br />Saddle Complete <br />.-.:.............................._...-._.._.........._...........?ipe <br />Service Cock <br />Service Box <br />No. Horns Labor....................... ... ........... _..... cost ... ....... _......... ............................ <br />Cutin ................. ... Pavement ............... .... X .......... ........ .. ....... ... _........... Sq. Ft. <br />................... .X...... ._............ .. <br />J <br />...................x..........._........... <br />Total ........................Sq. Ft. <br />.... ....... <br />OrderReceived.............................................................. ...... .................... <br />Work CompletedJ.1.=..;!:.-f_St............. ..............._...._:::s..........reman ....... <br />Q <br />