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5 1. Prirhe�N ].4b2?1W/ � 3 �• C-(.� V. <br />N. D. F�rm ] • <br />CITY OF EVERETT--Water Dept. �_, <br />i�-,� � �l <,_> <br />Application No.<.�_�::.:..._:. Date . •.:::.. .- � - �- � - 19 �..:� <br />- � , .. .... <br />. Install.......�_ ...................inch water service pipe <br />�- _ l . <br />i/" r, ' <br />, , <br />,„ <br />�or ....._._.:---- ---- -_...,L.:..;::........_ .............._......................... <br />-) �7 �. <br />, . � . . .----.... <br />On ...........r.:_.-/...'.--....( _ Street <br />... ...................... _. _.. ......... _................... ...... <br />I,oL- ................/../..-..!.�..._...._ • ........ Block No. ..:.1.......................... <br />Addition � <br />._ ........................_.....--.. _...................................... .......__........ <br />Retnarlts ..._� ........ <br />_.... ...._.. <br />, .................................................................................... <br />....._ .......................... ...............__..................-� -....................-- <br />�� ..............�. - .._ <br />*:._ ............................... <br />.........................._....................- ----......... <br />, <br />�',......_.........._...._ ......................................!:........--....... /. ..._.......:.._..... <br />�? ' .. / <br />� ........_ ......................._.....................,�........,:.:.....:._,,......._c...:...:.:.--::::... <br />' � Sup�rrintendent <br />� Lh[301�, AND BfATdi2IAL tiSED <br />Fo. Size <br />. �'� I.cad Conrection Complete <br />. j Saddlc Complete <br />..... ................... <br />Se vice Cock <br />Service Box <br />�i <br />No. Iiours LoUor <br />Cut in...._....._....... <br />Pipc <br />........................Sq. Ft. <br />........................ .� <br />....................X...........:............ �� <br />........................ <br />....................X........................ �� <br />........................ <br />Total ........................Sq. Ft. <br />-- ----- � -- - -- ---- -----' <br />, /; ; � ,�. . ---_- <br />R e m a r,c s...� ............:.:...................:.....:............................. _............... _.... ....... <br />. r <br />OrderP.eceived . .........................................................- _....:......_........_,....... <br />i <br />�Cork Contpleted_._�...' ..............._.:.......'.......::i:.�. ' - .. <br />. ...........: ............ ....:.:..... ... <br />Fore:nan � <br />