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82 76 � c � <br />W. D. iORM i f <br />�. . .. _..__ <br />..:�� <br />ACCt. NO..... <br />CITY OF EVERETT—Water Dept, <br />ApplicationNo ...... ...................... Date...................................... .............19........ <br />Install ................................ inch water service pipe <br />r, <br />Owner-----....f.'..�........._��2.�?..:�r... �'..: S.< ............................................................... <br />Address---•_''�,._�/ /Icx, 3-> ? S.-„ �, ,/. . ' / <br />� •.K �s :- <br />-� ..............---• ---............._---........_ ..........._.---......-------........ <br />Lot.---�� ................._...............--�-----........... Block No................._...----��---- - --- <br />Contractor..._ .................................................................................._.._...................._. <br />Rem�.:;cs......._......_.------ ....................................................-•_-............................--.. <br />3 .. <br />. �,�.....��, .p... .............................................._. <br />.............................�-�----�--....................... <br />... �_�-�-��...._......._ ...............�--�----��--��-----........................_.......-�--��--�-----�-��- <br />Amt...................._................... Rec. No...._.............................._......_........---�--......-- <br />By......--• ..................................................---........................ <br />6uperintendent <br />... �, , . <br />�:.! ��. �. °'..�...... �. � _�?.:S! �:..�_ .............._............-----..........---.............._. <br />----�� .... ......................... <br />.............._�✓�e1`'ei._ �3S`l/ <br />................---.._.....----._• -- -. _ . <br />Shop <br />� <br />WorkCompleted ..................................................................................................... <br />Foreman <br />