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. �„�,.3�,5- . � _ . <br />W, O. FORM i � � <br />. • ACCC. IVO ................................. <br />- ' CITY OF EVERETT—Wat r Dept. <br />/ , <br />�f > ,` t i <br />Application,N l � . � Date......�...1.._.._.._� ................-.......19....... <br />q/ ( .� . ....._.. <br />�% ... ... .... . . . . <br />Install...........,<...._�........ inch water service pipe <br />Owner .............................. ................ . ..................................... <br />� � - <br />�........ �.. <br />. . ._/ . <br />Address......._..r�..L...�: ..�.._.L_ .............� `c..�......�..�..............................._........... <br />r...r - ................ Block No........_..................................... <br />Contractor.......i .:.......................... �..C`.. .y......... J...................---- <br />_ � — �— ti e ._ t �� ." <br />� <br />...................... ........ ........................................................ <br />Amt........�.,...�.......'......... Rec. No ........................ <br />� <br />Shop <br />.................................... <br />Superintendent <br />................... _ .............. _,................--- <br />.........................................x.......�. , �. <br />.� , <br />I ,'�� � ..........� "� ;�-� . ....� r—� <br />t <br />WorkCompleted..:.......�_i........... ............... ...__......:.................._.........._. j <br />Foreman • <br />