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3 J, Pibe4)i7A <br />W. 1). Form 3 429 <br />CITY OF EVEREETT—Water Dept. <br />Application �Date...... <br />7's <br />Install....17 ..................inch. . yrvice pipe <br />ar service <br />For ...... ....... <br />........................... <br />............. ­ '" <br />Oil................ I ........ ........ ............ .. .'Street <br />.............. ................. <br />Lot —.— ..................... ;F..�. ................. Block No ..... ...... <br />Addition ............ . <br />................................... .... . <br />Remarks ........ <br />........................................ ................ .................................................................. <br />................ <br />LAHUR A' ND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />Service Cock <br />Service Box <br />.................. — .......................................................................................................... <br />Order Received <br />Work <br />.. . ............ I .....-Foreman <br />