HomeMy WebLinkAboutPERMIT APPS - 04-00254 - 955 Hillview Dr - New SFRWORK ORDER
ACC# RT# PHONE EFFECTIVE DATE DATE -7-1)V
NAME
ANA, nahcZ SERVICE ADDRESS //yirw �dt
MAILING ADDRESS 370 TA /or�
OWNER :bnn Dunn PHONE Sa1IHS9 NO. OF PEOPLE
ADDRESS _ Name
EMPLOYER OR RELATIVE WORK PHONE _
COMMENTS
SS# .5/9•611-7/11�1
SIGNATURE
Water A%eter .......
❑ IN
❑ READ
❑ RENTING
❑ ON
❑ RE -READ
❑ BUYING
❑ OUT
❑ CHECK LEAK
❑ SELLING
❑ OFF
❑ WTR.SWR ONLY
❑ OWNER
❑ VACANT
❑ GR CONT. #
❑ BL CONT. #
METER SIZE _
LOCATION
COMPLETED BY
NAME
ADDRE!
DEPOSIT AMOUNT
DATE PAID IN
REFUND DATE _
AMT. REFUNDED
AMT. APP. BILL
GR RT# BIN SIZE NO. OF BINS
ISSUED BY
0TD WD TD FD 0
APPLICATION FOR REXBURG CITY SERVICE
❑ COMPUTER FILE
WATER SERVICE: Type I Size
314
Water Connect......:
r
Water A%eter .......
S
Meter Box .........
t
Ring 8 Lid.........
{
Curb Stop .........
$
Saner..............ti
Sink Trap
Sewer Connect .....
_
TOTAL ............
_
In City _ Out of City
Storm Drains — $
APPROVED BY
Address
Lot Blk
Name
Address
Use
CITY OF REXBURG
APPLICATION FOR PLUMBING PERMIT
[0PJIktl
Te I.
Add. _
PLUMBER
—Tel.
NATURE OF INSTALLATION
Rough Plumbing
1
Septic Tank
Fixtures
Water Piping
Complete
Sewer
DESCRIPTION OF WORK
Bath Tubs
" Urinal
Showers
Sink Trap
Laundry Trays
I Water Heater `
Wash Basin
Other
Toilet 11 3
Slop Sinks
Kitchen Sinks
Floor Drain
Drinking Fountains Lawn Sprinklers
Water Softeners
Dish Washing Mach.
Clothes Washer \ I
FEES
Plumbing Permit • • . . ... ...... $
Sewer Inspection •...................$
Inspection of Pipe • • • • ............... $
Inspection of Fixtures • . • ............. $
Received: Date
By —
M
Rough Plumbing
Sewer
Other
Finish Plumbing
$
$
TOTAL $
INSPECTOR'S RECORD
N
S
INSP. NAME
2