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/v�?z I l <br />CITY OF EVERETT-Water Dept. <br />Application Ng a..V. .. Date.................. ¢Z:...1.............. .... <br />19 <br />Install. .................. . ........... inch water service pipe <br />Owner........... _.._................................................................ _ <br />Address....... . ....... _.................... .... <br />Lot.............................................................. Block No .................................... ...... <br />Addition ................... _....... <br />Contractor .... ....... ...... .......... <br />..........._.........._.........................._..._._._......._.......... <br />Remarks........... �1._ Gl lP.......................... ...... _.................................... <br />.......... _ <br />Amt................................. Rec. No ........................ .......... .............. . ....... <br />................. �_...�. :,y...... <br />Superintea=r <br />Shop Remarks ........................................................ _».......... ................. <br />_.._.._.. <br />WorkCompleted................................................................................................... <br />Foreman <br />