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/79,�� ��_,�A � <br />W. O. FOflM 3 <br />Acct. No..1•,'�.,�..�..�.�....... <br />CIT7 OF EVER,ETT—f Water Dept. <br />Ar,plicatiun No...1.�Z.I��c...... Datc...�/�l_3:--.�..:..�_�i.` ................19....... <br />Iustall ..................._........... inch water service pipe <br />Lot--.......... <br />Block No... <br />--..... Rec. No .............................-----.........................------ <br />� � ����-4�L z <br />B;� ............................................ ••------i..--=-- ---.:............ .: <br />Superinte�dent/ <br />,��� <br />Shop Remarks ..................................-- ......... <br />...-� .................................................................... .. <br />......................... ...................................... ........ . <br />............................................................................. <br />................................. � ...................................... <br />.............................................................................. <br />....................................................... .................... <br />.................. .......................................................... <br />.............................................................................. <br />�O�ork Completed ..............................._............ <br />..... <br />Foreman <br />�-� <br />