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W. o..o,w , 19667 1 Acct. <br />CITY OF EVERETT—Water Dept. <br />Application No%PIOX�1.,%... Date................. _-:?= ...................... 19...i- <br />Install ........... ....... ........ ... inch rater service pipe <br />Owner..................................................................................._...................... ....... _...... <br />Addivss...... . .% .. -... .a..... ....................... ........ ....... ... <br />Lot........................ _.................................... Block No .................... _._....................... <br />Additiun................... _.............. _................... .............................................. _.............. <br />Contractor........... .......... ... ....... ................... _.............................._.._......_......_.._.. <br />Remarks...........1.�t�F <br />Amt....... _........... Roc. <br />By....... ... ............... .............._.._.................._............_. <br />Superintendent <br />Shop <br />WorkCompleted ..... ......... ....................... ................................... _................... <br />Foreman <br />