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W. D. FOR" s , S �Y c�J - 1 r) <br />CITY OF EVERETT—Water Dept. <br />Application ......... Date ..................... <br />Install ............ ...... ............ inch water service pipe <br />Address............ rf'4'.. �..- . <br />:.................I...... _.. .............. <br />_ ....... <br />Lot....... ....... _............................................. Block No...._......_......_.._. <br />Addition..._ ..................... _...... .... .............. <br />Contractor --- -.._--_---_ <br />Amt...._......_.._.............._.._... Rec. <br />By........... ............... .-.-....._..._._. <br />Superintendent <br />ShopRemarks.............................................................. <br />Work Completed- ..................................... . . <br />Foreman <br />