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11 <br />CITY OF EVERETT WATER DEPT. <br />APPLICATION FOR SERVICE AND/OR TURN ON - SHUT OFF ORDER <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE ORDINANCES <br />AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING OR AS SAME MAYBE <br />HEREAFTER CHANGED. <br />TYP BCD I NO, SUB TYPEcusr. REV. SIZE UNITS <br />a. <br />DATI(19'9 <br />❑APPLICATION ❑TURN -ON ❑SHUT-OFF OTHEJ <br />ADDITION 4 yR _BLOCK LOT <br />SERVICE ADDRES <br />CONSUMER OWNER ❑ <br />D.LW % <br />TENANT <br />"d4 A <br />OWNER t'�SLLRi L_! <br />RECEIPT ifa AMOUNT <br />DEPOSIT <br />PAID <br />NUMBER ddd IJ SIT RECEIVED $ BY747 <br />�- <br />SIGNED: X A crt <br />!''� <br />O <br />REMARKS <br />SERVICE <br />NO. /OC (4, 7� I.'i C�J BY �•-!%�� / 1! <br />WORKCOMPLETED <br />� V HtMNIV <br />APPLICATION NO. <br />/3t05) <br />