HomeMy WebLinkAboutWORK ORDER - 04-00309 - University Plaza - Strip MallAPPLICATION FOR REXBURG CITY SERVICE
NAME
ADDRESS X363 Aju 53
PLUMBER
PROPERTY OWNER EPIC 62t6kSCA1
WATER SERVICE: Type Size
Water Connect......
$
Water Meter .......
$
Meter Box .........
$
Ring 8 Lid .........
$
Curb Stop .........
$
Setter ..............
$
Sewer Connect .....
$
TOTAL ............
_
In City Out of City
Storm Drains — $
APPROVED BY
WORK ORDER
ACC# RT# PHONE EFFECTIVE DATE
NAME EMC Lr(,Ql(�At SERVICE ADDRESS
MAILINGADDRESS LSY(p (,J MAIA3 f?L< X Car rd
DATE
OWNER 4 PeP_ Mer-66PA PHONE 3S1,-JNSJ3_ NO. OF PEOPLE
ADDRESS
EMPLOYER OR RELATIVE WORK PHONE
COMMENTS
SS#
SIGNATURE
❑ 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
DEPOSIT AMOUNT
DATE PAID IN
REFUND DATE
AMT. REFUNDED
AMT. APP. BILL
GR RT# BIN SIZE NO. OF BINSM T ❑W T❑ F S
- El
ISSUED BY
❑ COMPUTER FILE