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CITY OF EVERETT WATER DEPT. <br />APPLICATION FOR £ �_.EAND/OR TURN ON - SHUT OFF ORDER <br />I HEREBY APPLY FOR THE <br />_ OF WATER IN ACCORDANCE WITH THE ORDINANCES <br />AND POLICIES OF THE W.. ER DEPARTMENT NOW EXISTING OR AS SAME MAYS <br />HEREAFTER CHANGED. <br />TYP[ H[v. gIZE <br />TYP BCD NO. SUB �usi CI. <br />DATE �. <br />�APPOCATION <br />TURN -ON ❑ SHUT-OFF I ,OTHER <br />I_J <br />/ [�U <br />,y <br />BLOCK <br />LOT <br />ADDITION <br />970 % - T72� <br />I I <br />SERVICE ADDRESS <br />OWNER ❑ I <br />TENANT ❑ li <br />CONSUMER <br />I i <br />— on <br />OWNER --7) • s& <br />n <br />CONTRACTOR— <br />PAID <br />RECEIPT O ❑ FIXED AMOUNT <br />IVED� 3 <br />BY <br />NUMBER DEPOSI' RE <br />, <br />-- <br />�0 <br />SIGNED <br />REMARKS: <br />SERVICE 4 9 �L' _ BY <br />ORDER NO. <br />APPLICATION NO. <br />1348 <br />WORK COMPLETED <br />