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w. c.�ror.r a � � S� / <br /> CITY OF EVERETT--Water Dept. <br /> Application No... .l�lrl. Date........... ..` .......................191, <br /> Install...............................inch water service pipe <br /> For ........./....................................................................................................._. <br /> On ......7.d. ...:. .....�./ ...................................._._....... Street <br /> Lot........................................................... Block No..............._................. <br /> Addition ......................................._..................._............................................ <br /> Remarks ......................._................................................._................._........ <br /> ........................................................................................................._._......._.._.. <br /> ...................................._......................................................_..._.._.._......_........... <br /> ....................................................................._..............._................._._..._.._.._... <br /> ............................................................_.................................................._ ......... <br /> Superintendent <br /> • LABOR AND MATERIAL USED <br /> No. Size <br /> .................................................. Lead Connection Complete <br /> .............................................. Saddle Complete <br /> ..................... t.__.................... ................................................_.................Pipe <br /> .._......................._........................ Service Cock <br /> ......_........................._.._............. Service Box <br /> No. Hours labor....................................._.Coat......._._..___..__...................... <br /> Culin....................Pavement..............._..X0................. ......................Sq.rt. <br /> ....................X.._........_....... <br /> .. <br /> ...................X....................... .. <br /> ........._.........X........................ " <br /> Total ........................Sq.Ft. <br /> Remarks_........ ...-..................................._.._....... _ ....._ ................................. <br /> . ................ ...... ................................................................................./e�man <br /> ........................................................................................._.. <br /> OrderReceived- ......................................................................._.. <br /> WorkCompleted........... ............................................................... <br /> F <br /> r-* <br />