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W. D. FORM 3 11�pe qez - <br />Aect. No;12y�,, <br />.:n;.:2 .... <br />CITY OF EVERETT—Water Dept. <br />Application No .... 1.L.21 .... Date ....... /o..4.................. 19....... <br />inch water service pipe <br />Lot........ ...... _.............. .............................. Block No ............ ........ .............. ........... <br />Addition............ ...... _.............. ....... _.................................. _... .......................... _...... <br />Contractor............................................................. ..................... .------._......_.. <br />Arat........ ........ ......... ............ Rec. No .... ....... ....... ................................................ <br />By. ...... ................... _.............._......_!.t........:................ <br />Superint,,,,ndenY <br />ShopRemarks ............................................................................................... <br />............................................ .............. _.._.......... _....... __... .... ...... ....... ...................... <br />WorkCompleted... ............ . .............................................. . ..................................... <br />Foreman <br />