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Aect. <br />CITY OF EVERETT—Wate Dept. <br />ApplicationiNo(.�../..... Date ........ .�.................._...19 <br />Install.......... f ............... inch water service pipe <br />Owner............... _.................... _....1................................. ............... ...... _..I......... <br />Block No........... <br />Rec. No ............ .......... ........... _._...................... <br />..... <br />5 S. S w --(_.' By................ ...... _... . <br />-�J.D No-rA) 5 Superintendent <br />ShopRemarks ....... ....... ............... ........ ......... ...... ........ _................................ <br />--.... ....... -•--•-.......-..............--...................._.........._..---..... -- <br />Work Completed......................._........:........F kt < L ^.............. <br />111 Foreman <br />