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W. D. fORM J lgaZ <br />CITY OF EVEIZETT. Water Dept. <br />Application No..... .... Date....... :�Z / ...... .............. 19 ........ <br />Install..._.._.._.._ ............... inch water service pipe <br />Owner.........._..._.........._ .................. . .. .... <br />Address................... �LA:.... ......................................................... <br />Lot..........._......_.........._......_ ..................... Block No............_......_._........._..__-_ <br />Addition..._ .............._.._.._ . .... ................. . .. ............... . ...................... .......... .... .. <br />Contractor... ............. . ...................................... . ......... <br />Remarks.................................. ........................... <br />------------ --------- ------------ . ..... . ...... . . ............ <br />Amt....... ........................... Rec. <br />By......._ .......................... .....irn <br />ShopRemarks ............. ................................ ............. ........... . ............ ......... <br />Work Completed ............................ <br />..................................... <br />Foreman <br />