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{' <br />W. C. FORM ] Acct. No... _ ............... �. <br />CITY OF EVERETT—Water Dept. <br />Application No.../.-!..'Date..............�C: z..:.. _ ............... <br />Install. ............................... inch water service pipe <br />'.' (.... ��......fi '!....... _......_.............._......_......_...... <br />Owner....... ....... <br />Lot.... ............... .......................................... Block No .................... <br />Addition.................... ...................... _...................... _............. ......... <br />...... _............ ........... .....--- ._.._.----- --------- <br />Amt........ ................................ Rec. <br />............................... <br />y........................... _.............. _. Superintendent <br />Shop Remarks ............... ....... _.._.._.-...._.. <br />....................... .........../ <br />Work Completed................................................................. Foreman <br />