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w, o. ronw a / ;�a <br />CITY OF EVERE*—Water Dept. <br />Application No .... l..%.G1...... Date........;3..'..1..-.G>.. ............_...IB..._... <br />Install.........._.._..__......... inch water se. -vice pipe <br />Owner................... _.......... ... .................... <br />.. ..._.... . <br />Address ................... <br />Lot............ ................ _..»..... <br />Addition ........... ....... ....... _................ _..... Block No .................. .... <br />................ <br />Contractor...»..._.._......».._.._......_......_. <br />......................................... <br />Amt.__ ___...». ._..»..»... Rec. No ................... _......... <br />B�1gBItnf071dant <br />ShopRemarks ................................... ........................... <br />Work <br />