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V/. O. FOIiM 3 �� �' ' � � <br />� � �.s0 ,,�i ,� .���c. r�a..��.' �. � l...z- <br />CITY �F EVPRETT—Water C�ept. <br />Application No_f.f."..�.:�.:f: Date ..................�.../......................19.�.� <br />Install ................................ inch water service pipe <br />.i � — � 1" �Iz.....l�v� ................................... <br />Address__._._,....... �.�/ C .............. . - <br />i.oL - - ......._ .................._................ Blocic Na............................................... <br />Contractor.._......... --�-� - . ....... .............-......- -......................._.._............................. <br />Remarks ............: ..:.....!�� �..............- - ................... ----................................_...... <br />f '"'_ <br />Rec. <br />Superintendent <br />Shop Remarks ......................... <br />1,�'ork Completed .............................. . ..._...._................--...............Foreman <br />