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� <br />, shalltbe�treated��z�n.a 4I£1tP.T Distr.' 't��and�com*+lynw�th 4faterSDistricter° <br />rPQu.lations. � <br />Water Ulstricts are requiren to fi�l in �nd .ret��rn this foxm to the Clty <br />/'1 of Everett, Uti.l7.ti�:� DF;n;�rtment, 5vr.rr.tt., :�'��1;7n?'ton t)8201. It �ay be <br />��1 mrziled or bron3ht in, with your r:::;���!�t or senarately. If yuu have any <br />� questions, nlease c�.11 I•:�,•s. 6app aC 259-P�?g5• <br />Dlease r.eturn the connl�tc:u f'orm wi.thln 20 day� of recei.nt to: <br />p�:rs. Sa;��;� - utility Billir.� <br />Ci,ty of Everett <br />Everett, 4:ashir.gton 98201 <br />';lATEl: DISTi3ICq' RE�GR?' <br />Name. of �dater District (if �tny) �-'u`s��� �•��"^ V''t, '�� <br />Treasure.r of rayer:, ^AHm yb ��1� �N�^� y <br />.;,�.� e <br />1�0.4 I� �hl�� ✓a.,Y, _ <br />;,aat��s:; <br />�,. � r�-� W Q� i� .�i ff� <br />City, 5tiate, L1n COd <br />��2- ��ST <br />Tel.enhone i7umoer <br />persons to notify ln case of emer�enc;� -[d�im�, l�dl:ess,'Telenhone AlumbeT: <br />�; <br />�SAK�e ha Ah.,,:� <br />1�,.� <br />Total numbe'r of ser��ices connected to the master meter /� <br />Present numbcr o. �•ervices ln us�_ <br />Account Number %C�T�� <br />Tan PJumber %��- <br />SizP of Service � ��' <br />Date D1ailed �n�'d'd — <br />1 � ,' . <br />�� � <br />