HomeMy WebLinkAboutWORK ORDER - 04-00207 - 630 Autumn Dr - New SFRWORK ORDER
ACC# RT#
❑ READ
PHONE EFFECTIVE DATE/
DATE
NAME �(�_,{017
❑ BUYING
, SERVICE ADDRESS /_0/ /2
Q/ock / Norwr,/ H4r„4.
MAILING ADDRESS
❑ OFF
W. C•Ic% Prx&n.
Ff3%YO
OWNER ;OXc4 r /-/o✓>{on•
ADDRESS
EMPLOYER OR RELATIVE
COMMENTS
SS#
SIGNATURE
❑ IN
❑ READ
❑ RENTING
❑ ON
❑ RE -READ
❑ BUYING
❑ OUT
❑ CHECK LEAK
❑ SELLING
❑ OFF
❑ WTR.SWR ONLY
❑ OWNER
I—, VACANT
❑ GR CONT #
❑ BL CONT. #
METER SIZE 3/y GR RT#
LOCATION
COMPLETED BY
-,3Ge,S-7S NO. OF PEOPLE
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 AnlLalJ1
ADDRESS 132 Z .il �le L SuP - ' �i
PLUMBER -Te ki oar4
.lam' Cid
WATER SERVICE:
Woter Connect......
$
Water Meter .......
$
Meter Box.........;
Ring 8 Lid .........
$
Curb Stop .........
$
Setter ..............
$
Sewer Connect .....
$
TOTAL ............
t
Size
In City Out of City
J U N- 2 2004 Ll
APPROVED B
CITY OF REXBURG