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Aect. No.../Gl.../ •(.✓•�• <br />CITY OF EVERRRE T—Wator Dept. <br />Application No. _.yDate............. ......... ...: L....._...........19.1c.Y <br />Install ............ .................. inch water service pipe <br />Owner........ ....... ..... ...... _........ ............... .... ............. ............... ........ ..... ......... <br />Address ...... .16..-__�......:!...r `................. _..... <br />_._.._.._... <br />Lot................... ....... ............ Block No .................... _........ ........ ... <br />Addition.... ..................... _. _....__.........._.. <br />Contractor..._........__........_.........._......_........._.._.........._......_.._.._..___...__......_. <br />pcmarks......./• G¢—.............. ...... ...................... .................. _.......... _... . <br />ec. <br />......... ___........ ..6upe.......rinte..'t'e' .nde....nt..._..... <br />ShopF:marks............... .... ............. ...... .._......_.._._ <br />Work Completed .......................... _.""""""". ....................._......................_........ <br />Foreman <br />