HomeMy WebLinkAboutWORK ORDER - 04-00251 - Parkside Townhomes - ClubhouseWORK ORDER
ACC# RT# PHONE EFFECTIVE DATE DATE
NAMEC—,6QAtrn6U j2Eu SERVICE ADDRESS
MAILING ADDRESS 51-237 ti.
OWNER
PHONEa2--f2V-67? j2 NO. OF PEOPLE
ADDRESS _3a/itF Ars ,¢pn -
EMPLOYER OR RELATIVE WORK PHONE
COMMENTS
SS#
❑ IN
❑ READ
❑ ON
❑ RE -READ
❑ OUT
❑ CHECK LEAK
❑ OFF
❑ WTR.SWR ONLY
❑ VACANT
❑ GR CONT. #
METER SIZE GR RT#
LOCATION
COMPLETED BY
NAME
UPD•4
SIGNATURE
❑ RENTING
❑ BUYING
❑ SELLING
❑ OWNER
❑ BL CONT #
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
PLUMBER- 4YAA%�' A /Z4(,
PROPERTY OWNER LISd e✓1✓ .O
WATER SERVICE: Type Size ' Y.� ,/
Water Connect...... $
Water Meter .......
$
Meter Boz .........
$
Ring 8 Lid.........
$
Curb Stop .........$
Seiler ..............$
Sewer Connect ..... $
TOTAL ............ $
A
In City Out of City
Storm Drains — $
APPROVED BY