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1Y. O. FORM B <br />Acct. N� 25 ...... 5 _... <br />CITY OF EVERETT—Water Dept. <br />Application No IT- �� 'd'.. Date ............ !?............ ...................19.�f <br />Install ........ ...... _.............. inch water service pipe <br />Address ....... _ <br />Lot............................................................. Block No ........................ _.......... _...... _.. <br />Addition........................................................... _........................................... <br />......._.._.. <br />Contractor... _...... _...... _...................... ................... <br />...... ................ ........................ <br />Remarks ....... _.......'? .:Z. ..................... <br />Amt..................................... Rec. <br />By.....................!_.�....% r�....... <br />Superintendent <br />Shop Remarks ............................ <br />............. ............... ................................................ ......................... _............ . ............. <br />Workompleted.................................................................................................... <br />Forem <br />