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` \ � ` - <br /> W. O.`�M � � • • . <br /> ACIC. NO................................. <br /> CITY OF EVERETT—Watcr Dept. <br /> . �} <br /> ' • c: �_-� ..:. :�-........19._-... <br /> Application Na.�Q!_..� ,:.� Date......:........_ . ......... . . :_� C <br /> Install..............:::�.........., inch wate`r service pipe <br /> ,, I <br /> �_- - i-,��r�--•,N �{�� <br /> Owner......_�....ti�.`....�:..�....:....:� _ .. . . <br /> / _7�� �f'':.-..... ) <br /> . <br /> Address.......��?.�� ✓/"._.�.-:..'_�.;"_t:^...l.�:.. .���-4'�...:.ti.�.'.J.... <br /> . ............ . <br /> Lot.............._........_._. ...- ......._.........._..Block No.........._.................................... <br /> Ad d i t i o n....................................................................................................................... <br /> Contractor.....r.:................................................T� <br /> Remarks....l'l�v�..:?.'..zt L.c��..,r�:..�,.`........._......_......_........_.._............... <br /> ....................................................................................................................................... <br /> ........................ ....................................................................... ............. <br /> ............... <br /> Amt................................. ...... Rec.No..... .....;:.........:.................. ..................... <br /> By.......................... .....1...�.....�•-�,.:s.'... .....:........_.. <br /> � � /n/W�erin��nt <br /> V <br /> ....................................................................................................................................... <br /> .......................................'--.......................................................................-�--�--............... <br /> •"'................................................................................................................................... <br /> ..............................................................................................................."----.................. <br /> ....................................................................................................................................... <br /> .............................................................................................................""..................... <br /> ................................................................................................................................'---... <br /> ......... ............................................................................................................................. <br /> ShopRemarks........................................................................................................... <br /> ...................................................................................................................................... <br /> ............................................................. .............................................._...................... <br /> ....................................................... ............................................................................ <br /> ....................................................................................................................................... <br /> ....................................................................................................................................... <br /> ..............................................................................................._...................................... <br /> ........................................................................................... ......................... .............. <br /> WorkCompleted..................................................... _.......................................... . <br /> Foreman <br />