HomeMy WebLinkAboutWORK ORDER - 04-00215 - 638 Cook St - New SFRWORK ORDER
ACC# �+ RT# PHONE EFFECTIVE DATE
NAME / R��7 f SERVICE ADDRESS
MAILING ADDRESS
OWNER
ADDRESS -�-S-'9 N,
DATE
PHONE 35-9-NO.OFPEOPLE
EMPLOYER OR RELATIVE SFL WORK PHON E
COMMENTS
APPLICATION FOR REXBURG CITY SERVICE
NAME TZ^V T �!I
ADDRESS 3 S'9 %,� Z �. ��X R LAI G
PLUMBER
PROPERTY OWNER �i✓T'el�
WATER SERVICE:
Water Connect...... $
Water Meter .......
S
Meter Boz .........
_
SS#
_
SIGNATURE
_
IN
❑ READ
❑ RENTING
DEPOSIT AMOUNT
❑ ON
❑ RE -READ
❑ BUYING
DATE PAID IN
❑ OUT
❑ CHECK LEAK
❑ SELLING
REFUND DATE _
❑ OFF
❑ WTR.SWR ONLY
❑ OWNER
AMT. REFUNDED
[]VACANT
❑ GR CONT. #
❑ BL CONT. #
AMT. APP. BILL
METER SIZE
tr GR RT#
BIN SIZE
NO. OF BINS o Ll o o a a
LOCATION
COMPLETED
BY
ISSUED BY
❑ COMPUTER FILE
APPLICATION FOR REXBURG CITY SERVICE
NAME TZ^V T �!I
ADDRESS 3 S'9 %,� Z �. ��X R LAI G
PLUMBER
PROPERTY OWNER �i✓T'el�
WATER SERVICE:
Water Connect...... $
Water Meter .......
S
Meter Boz .........
_
Ring & Lid.........
_
Curb Stop .........
_
Setter ..............
_
Sewer Connect .....
$
TOTAL ............
5
Size
In City Out of City
Storm Drains — $
APPROVED BY