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w. 11. IOIIY l /4071 • �� �: � .� `� <br /> CITY OF 7EVERETT--Water Dept. <br /> Application No..f ./.- -i... Date ..........».............18 7 <br /> Install....._.......................inch water service pipe <br /> For ............................................ ...................................................................... <br /> On ...... Z--.l loG _...... Street <br /> Lot............................................._. _-.._... Block No............................_.. <br /> Addition ............................................................................. .......... ................. <br /> Remarks ........................................_.. ..._..»...................................... <br /> ............................................................._.......................................................... <br /> ftiMrinlendent <br /> LABOR AND MATERIAL USED <br /> No. Sire <br /> ............_................................... Lead Connection Complete <br /> .............._.................................. Saddle Complete <br /> ...................ft._....................... .................................................................pipe <br /> ............ Service Cock <br /> .._.............................................». Service Box <br /> No, Hours Labor..._.................._.................Cost.......................................... <br /> Cut In....................Pavement..............._..X_............... .....................Sq.Ft. <br /> ...................X.......»........... 1. <br /> ...................X..........._.._...... .. <br /> ....................X....................... ........................ <br /> Total ._....................Sq.Ft. <br /> Remarks............................................................................................................. <br /> .......................................................................................................................... <br /> � <br /> .............................................................................................. ........._...__.._.... 1 <br /> OrderReceived..........................................................................._.................. <br /> WorkCompleted............................................................................................ <br /> Foreman <br /> i'r <br />