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By City Ordlnar�ce nny muter "=t��,,7 ir!; morc th.�n one nrr.m.ses or ue,er" <br />shall be treated �.^, a binY.er Uistrl t and oom��ly xlth 4lnter Dlatrict <br />rr.qulaL�ons. <br />1,��iter DLstricCs nrn r�nu:r�:ct to f1..1 in nncl ret��rn thls fur.m to the C1.ty <br />�1 c:' Everetr., litillY.l�a ficnnrtrient, :(vcrr,tt, :�L,sl;ln�;t;un 9f:201. It r.ay be <br />�� m:.11ed or Urou�:,ht 1�;, kiLh ;/ou.r »n?mr,nt or :sen�ratcl�. If you have nny <br />�- q�iestic�ns, nlease c,ll i'i•s. 6upp nt 259-�7R5• <br />P`�ease �eturn the c�:nrleted Porm tirithln 20 dsy: ot rcrr.int to: <br />;1r:;. Su:�n - l�tillty <br />C] ty cf' £•.verr;tt <br />(3verett, 'v!���hir.�ton <br />Billir,� <br />aF�7�l. <br />' ;kl': H I�ISiidIC'f R5°r•.,� <br />tdaroe ci' 47ater U;strlct '(1; anY) �V���•�e �r`��-�"/'/ ���-.��iL�a1G�� ,�• <br />Trer�sux�cr of raycr• Marmretu•a....� <br />' ::; x',- c; 6125 - 13Sth Aveauc SE <br />SmLomiaL {YatL. sa2�+n <br />' �dctTesc <br />� City, StaCe, ''ln Code <br />- � � .n <br />Tel.ennone <br />Tpersone L'o :.otif;� ln Cn:ac c;' encr;�::nc;� -:Cnrc,i ,,,:7drrs; , <br />.�l Ill.1,"C�Hu7` l'{y'-.eC_.'-r� � ,s lv d'' 'S� %D / �.?,t.! r.Ltr-er�--�. <br />��'�}� - {}- � C ( �'7'�`� <br />` /L, �.� - � �i t ���1 Tr_ �/�-�'�rr�c� S // 5 _ / 'i <br />!� � �I <br />t�v- s'v�� <br />� �� � p <br />� �=1.�n `+��Gu.t S F �ry,c� <br />y [s�- �i � Y.2 <br />� <br />� <br />✓ <br />�Pr.lenhone }?umber: <br />Cl, <br />S' 6.� � L� �1 C- / <br />Totc�l numbcr of scrvices connected t:o tne rszstr.r rcetcr �� <br />nr.es�nt numbcr ot' scrvicrs in u.��_ �� <br />Aaaount Alunibcr_� <br />Tan Numner. /� 9 <br />Slze of Servlr.e �� <br />Date h1n7.len -/ = <br />