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Q x) <br />w. o. icnu <br />7810� Acet.N5.-1o1f�? <br />CITY OF EVERETT- Water Dept-M-aa'<� <br />. t..-. ...4......_......_...19..._... <br />Application No .... l..:l.I..h.G.• .- Date ...... ....... <br />Install..._.._._.._.._....._••. inch water aervice pipe <br />Owner...... _..... .................. ..._.._........... ._..................... »............. ....... ....... »...... <br />Address..._.._..�..5.,�..�...- :..... ................... <br />.. ....._.._......... <br />........................ Block No...._......_......_.. ................ <br />.._.. <br />Lot..................... <br />Addition................................ ..».................... <br />Contractor ................................ ..... _....... <br />Remarks......._.._.._..__»......_......_....._........... _.........._...._.. _......_......_......_..___. <br />........... »......... <br />-- <br />.......Je �....._. . <br />y... _...... ............... __.gpuperintenden _. <br />..._............. <br />Shop Remarks .............. <br />......_......_.............................................................._....._......_....... <br />.......................................... <br />_......_......_............................. ................... ......... .............. _...... _...................... <br />...................... <br />Work Completed ........................ <br />............._.........................._........... Foreman <br />