HomeMy WebLinkAboutWORK ORDER - 04-00224 - Big O TiresWORK ORDER
ACC# RT# PHONE EFFECTIVE DATE DATE
NAME BI Co C::> ` IPE 5 SERVICE ADDRESS %(D A�o72T+f Znrn F
MAILING ADDRESS :7In r_)b 2.,jp e -
OWNER S/LA 4 C -r> PHONE 303-'-0Y_12?SNO.OFPEOPLE
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ADDRESS -710 IUo G
EMPLOYER OR RELATIVE
COMMENTS
SS#
❑ IN
❑ READ
❑ ON
❑ RE -READ
❑ OUT
❑ CHECK LEAK
❑ OFF
❑ WTR.SWR ONLY
VACANT
❑ GR CONT #
METER SIZE GR RT#
LOCATION
COMPLETED BY
SIGNATURE
❑ RENTING
❑ BUYING
❑ SELLING
❑ OWNER
❑ BL CONT #
WORKPHONE
DEPOSIT AMOUNT
DATE PAID IN
REFUND DATE
AMT. REFUNDED
AMT. APP. BILL
BIN SIZE NO. OF BINS
ISSUED BY
APPLICATION FOR REXBURG CITY SERVICE
❑ COMPUTER FILE
NAME —6 l Co TI 9 -t -L 5
ADDRESS —710 No1L-rt-t- 2-.n» � l
PLUMBER LC=w 5 Cy2F P(-UILlg4
r.✓� HEA,Trr{%
PROPERTY OWNER `P-5AA H CGp_'P
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WATER SERVICE: Type Size 1 Y,a2 M kerL
Water Connect......
$
Water Meter .......
$
Meier Box .........
$
Ring 8 Lid .........
$ _
Curb Stop .........
$
Seller ..............
Sewer Connect .....
TOTAL ............$
In City Out of City
Storm Drains — $
APPROVED BY