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/ V <br />CITY OF EVERETT--Water Dept. <br />Application No. . Date ___._....:...............................19..: <br />Install ....inch water service pipe <br />For......... ................ _..... .................................................. <br />On...... ..._.................. .... '... ...... _. </...................... Street <br />Lot.................. _ ...... .............................. .. Block No................................... <br />Addition..................................................................................................... <br />Remarks ... .�._/_/ <br />............. _.... ._..................... _..................... ... <br />Superintendent <br />'LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Snddle Complete <br />...»..»................ I Service Cock <br />. ............ .....:.... .I.. ..... .......... I....... Service Box <br />No. Hours Labor.............................................. cost .._................. _....................... <br />CutIn....................Pavement................... X........ ............... ....... ............... Sq. Ft. <br />................... x....... ............ .......»....._...... <br />....... ............. X...................... I. .r <br />........................ <br />................ ....X.................. ...... ........................ <br />Total __.................._Sq.Ft. <br />Remarks........._ _._...................... __..._ .........._ ..__._._..................... . <br />.............. . _ .......__.... ... ............. ......... ......... ...._._......................... <br />............................................................................................................................ <br />Order Received ............ ..... _. .......... _ <br />Work Completed ..................... ....__....._.-. <br />Foreman <br />