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CITY OF EVERETT WATER�DEPT. <br />TiiuN nN — SHLIT OFF OADER <br />ITi�i �co xo. su� �I cusr u� S1°° <br />,� - � � � --i�,i ��z z� <br />I-J On ❑ Ofl� ❑ Olhet _ <br />� � <br />Service Addrass �� - ' <br />6illing Address - ^ <br />uJC�Gtnia., �c�is„1 . <.G <br />Signed X <br />�-ai ,96� <br />oata <br />Appi. No. /�� �� <br />RECO�.�R�D� �OF �SQU,RN ON / S/HllT OF/F `� / <br />�urn On �"""'�i Q��`.��L 19�'� <br />Inspecled � Shul Off '�ato ` <br />� Remove Meter No.. -Reading - <br />� Install Meter No. - � e �ng � <br />C ❑ �^ 0/��� ��, <br />Ncw Sorvico �.7�_'z -C ¢_�Otf BY_��[-���C?�"-"_'�--_ <br />Insl�l;ed <br />BILLING DEPARTM[NT <br />OcSCPIPTION <br />Currmt <br />/,�� z. r <br />Remarks:— <br />Dato Enlered <br />�r":,�-�I <br />� z �9��_ <br />Sonitellon TOTAL <br />U <br />'^r <br />S� <br />ho 7 9 5 5,,.,� <br />�, � <br />