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M <br />Acct. <br />CITY OF EVERETr—Water Dept. <br />Date......................................... ....19. 0 <br />Application No-I-Z .. <br />Install..........._......_........... inch water service pipe <br />Owner..._.._ .............................. * ...... ------ <br />.,�9..e..... 4 ., .......................... .............. ....... .... <br />Address....... .. oA <br />Lot................... . ......................................... Block No .................... . ... .......... ........... <br />Addition..........._......_ .................. . ....................... <br />By ............. ......... . . e . n . d . e . n . t <br />Shop Remarks..._.._.. . . .............. <br />.1 ................ <br />Work Completed ................................ ** ......Foreman' <br />