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W. O. FORM <br />Acct. No.,If.�j:_.X...-3�.. <br />CITY OF EVERETT—Water Dept. <br />Application No....Date............:..-/.:: �v <br />Install ....... -..-..-..---_....... inch water service pipe <br />Owner ...............-. ' <br />Lot.......... -...... -......................................... Block No ................. � - .........._ <br />Addition..._................................................................. - — - <br />Contractor... <br />Amt.................................... Rec. No .... ............ ..._....C..�..................................... <br />By. .......................... -............._--_.....'�:..` U <br />Superintendent <br />,k-Cin <br />Shop Remarks ........... - .............................. <br />Work <br />