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/7GZ -. �' <br />W. O. FOPM J � . C � ' I <br />-" ' Acct. No.�:..j[:�..'I .............. <br />� - ' CITY OF EitERETT—Water Dept. <br />Application No... �. �I.L_��'1.......... Date......... �..-.1..:: �..`i .................._19........ <br />Install ................................ inch water ser: ice pipc <br />Owner....................................................................... <br />�A` '�._.;.......... _ ................................ <br />Address .............���.1.l. �.........1`:�!.r.r:_:r.C.!: :....1 �;. ��u.t'..:G...._........................... <br />Lot...............•---........................................... Al�ck No....................--••---..................... <br />Addition......................... ... ......................................................... ...................... ......... <br />Contractor.......................................................................................... ....................... <br />Amt......................................... Rec.Nc............---........................................_....---- <br />`'.L''.�=-4�5 ; <br />By .................... .................... �.:. ..:..----� . . .-� - <br />Superintende� <br />���[Z f <br />Sl�op <br />�1'ork Complr,ted.........._ .................._..._..._....--............._........................._........... � <br />Foreman <br />