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W. o. rnnn o 1 3� Acct. <br />CITY OF EVERETT--Water Dept. <br />Application No ..r....a1............. llatc................... �..-................._ ..19.....y <br />Install ....... .................... inch water service pipe <br />�� . Q. <br />Owner.......x�. % ....... ...�a1 ............................. ...._. ....._..... <br />Address.............. ... _...................................... .... ........................._.._.._......_...... _... <br />Lot................... ._..... ............ Block No ................ .._.................... ... <br />Addition....................................................... ..... <br />Contractor ...................................... .......... <br />Amt.... ___.._.._._..._.._.._... Ree. <br />By. .......... ......... ......... _.._.._.._........op-erintendent _.._.............__ <br />Supe <br />........ <br />Shop Remarks ............... ..._.... <br />Work Completed ...................... ................ ...... .............. ............. ..... ...................... <br />Faremar. <br />