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P.y City Ordlnnnce nny mete� "sunnl:ing more th�n nne memises or ucer"
<br />shall be trr_ated as a Wnter Distrt��: and comnly •.rlth 4late^ Ulstrlct
<br />rr.gulations.
<br />'dnter Dlstricts �zre requir�d to f'.11 in and r�ttirn this form to thn City
<br />�of Everett, Utllities D�:nnrtment, T�verett, 'dr�shln�kon 98Z�1. It �r.ny be
<br />_ mnfled or brought Sn, with your rr�>ment or cenarately. IS';/ou have any
<br />questions, nlease call I�rs. Klr�g a� 259-�7A5.
<br />Dlease return the comTleted form withln 20 dc�ys of' r�•r,,rint to:
<br />?:rs. Kfng - Utility Billln�•
<br />C1ty of Everett
<br />Everett, 4lashington 98201
<br />'�1ATF.4 DIST:iI�T RC°ORT
<br />tdame of !•later District (lf any) ,;a,v6s _
<br />Treasurer of rayer: 1JLs %%IN/FL t, ��v.ss'.?� ��
<br />Name / G �c!
<br />i.�� �� /�1r1Der+ LAKC RD. ( PO. a�X /
<br />paaress
<br />�.(r..hi s H . w.! . -r'L� -
<br />City, Sta.e� Zln Cadc
<br />'�/ – 85��G
<br />Telenhone P?umo?r
<br />�+-ws. -,mc.� t.� 4 , ri �2
<br />Dersons to notify ln ca:,e of emer�ency -,�as.e�, k�'dr� ::�, '_elen';r,::r ::u^�,ber:
<br />�� ��/�. U, E ,Ts .v/s S —
<br />_��. aox ��y
<br />jrw,�� �i.-�. � 92-s �-
<br />���-�y��
<br />��,
<br />�i0lIQ5T.V„i APPL[ANCE
<br />117 R Mein
<br />'D s � Monroc ...A 98277.
<br />�D •� f2nrt� •n, ��:g8
<br />_�
<br />Totnl number of servlces cor.nected r,o the m_ister R�rrr- �/y�
<br />nresent numUer of scrvices !n use_, f,�,� '/ _
<br />Account ?�rumber — Dal - r.�7 -. �p,},1 `
<br />Tan �umber ,� / i�L_
<br />Size of Service f"
<br />Date ;inlled
<br />' � �, �", ! , �_
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