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• D. FOflM16�1)e 1 N <br />CITY OF EVERETT—Water Dept. <br />Application No.... Date..................... <br />..1 .............. <br />...- - <br />Install ...... ._.......... ............ inch water service pipe <br />Address ..... _.......f�r.l......r� �.....<. <br />Lot......... .._.._......_.._ ............................. Block No... ..................... .............. <br />Contractor... »....... ...... ».............. ....... _.................. .............. <br />.....».._.._..... <br />Remarks........... _........�I..<..............................»......».._. <br />Amt............... .... . ...... ............ Rec. <br />By.................................................................... .................. <br />Superintendent <br />»........... »..... _._............. .......... ........ .......................... <br />ShopRemarks ........................................... _... ................................... . <br />Work Completed. .............. . ... ... ............ ........... i <br />.............................................. <br />Foreman <br />