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w 1 <br />ass` - <br />CITY OF EVERETT—W ter Dept. <br />ApplicE.tion NoI.�J.. .. Date...... .................. 19...� <br />Install ............................... inch water service pip° <br />Owner. .......... ................................... .................. ........ ... .............................. <br />Addres........I..� �............7_../..�....................._.._....................... <br />i..,, ... ....................Block No .................... .... .......... .......... <br />Addition..._................................................................. <br />Contractor ... .......................... <br />Amt...... . ...... :...._ .. Rec. No .... ...................... _......_.._.._...................... <br />By....................... ... _...... .... ........... ............................ ..... .. <br />Superintendent <br />....................:.C........... .... ............................ ................... ....... <br />.... ......................................................... <br />.............. %............ .... ........... ...... ....... <br />..... <br />Shop Remarks. ......... ... _............... <br />............................... <br />.......-.--- .................. i...... .... ................................... ..... <br />Work Completed ..... :........... /....................,�............,..�..,....................... <br />........... <br />r Foreman <br />