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iA/0ffVERETT <br /> WATER DEPT. <br /> APPLICATION FOR SERVICEANDioR TURN OIJ - SHUT OFF ORDER <br /> I HEREBY 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 /> TYP DCD I NO. I SUB ivPC RCv I SIZE UNIiS <br /> 9 DATE IO s'S <br /> r/I APPLICATION a TURN.ON❑91UT-Of!a OTNEP <br /> LADDITION BLOCK'_ LOT _ <br /> SERVICE ADDRESS /� 7 <br /> CONSUMER may^ /J OWNER ❑ <br /> TENANT n <br /> OWNER L� <br /> ACORC95 (� <br /> CONTRACTOR C �Gmp.Ao� <br /> AODNESS <br /> RECEIPT FIX EO AMOUNT PAID <br /> NUMBER D f - BY ' <br /> SIGNED: <br /> REMARKS iJ""�"` •-�` <br /> n I' <br /> SERVICE <br /> ORDER NO. `� O BY <br /> - . <br /> 1 Z 01 <br /> Cik/e- 4 4z <br /> (1 1(1k' LIGATION NO, <br /> I <br /> 1 L <br /> WORK COMPLETED <br /> FOREMAN <br />