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f <br />I CITY OF EVERETT WATER DEPT. <br />APPLICATION FOR SERVICEAND/OR TURN ON - SHUT OFF ORDER <br />114CREBY 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 />CUST DATE o? i9 <br />I`r�wl I�� • /9/oG <br />�j IAr'PLIC�A[TIp/JA_'�IJUflN--ON II/.S/NO/T_-0fi O—OT. KKR <br />nnYYA""\\oYYIIdrION'�✓Y BLOCK /_-��_f_ LOT <br />% _ l <br />RE <br />TYP BCD <br />TYPE <br />SERVICE ADDRESS <br />CONSUMER <br />OWNEP _ /T - <br />OWNER ❑ <br />/1 TENANT ❑ <br />RECEIPT � FIXED SO O <br />NUMBER � DEPOSIT R OEIYFO f PAID <br />SIGNEO: X <br />REM S: Ta• / <br />SERVICE <br />ORDER No _ BY / • <br />• <br />WORN COMPLETED <br />