HomeMy WebLinkAboutWORK ORDER - 04-00312 - Purrinton PlazaAPPLICATION FOR REXBURG CITY SERVICE
NAME
ADDRESS n - , 130 J ���� g3 ye--
PLUMBER ACAb M f �KMglhlL�i
�� I
WATER SERVICE: T
Water Connect......
_
Water Meter .......
s
Meter Box .........
S
Ring 8 Lid.........
_
Curb Stop .........
s
Setter ..............
s
Sewer Connect .....
_
TOTAL ............
Size
z''
In City Out of City
Storm Drains -- $
APPROVED BY
1ffe•i� i1
ACC# RT# ^MPHONE EFFECTIVE DATE DATE
NAME L�C
lAiAAr
�S, A- CY6"T-SERVICEADDRESS
MAILING ADDRESS QD ZO)6(3 TCMK� Td 8345
OWNER &18 CAItLso� PHONE 70f-j1`(6:Y NO. OF PEOPLE
ADDRESS _1. JGr�U(zp(r
EMPLOYER OR RELATIVE F -O k` (QruLtdE4feotip WORK PHONE
COMMENTS
❑ IN
❑ READ
❑ RENTING
❑ ON
❑ RE -READ
❑ BUYING
❑ OUT
❑ CHECK LEAK
❑ SELLING
❑ OFF
❑ WTR.SWR ONLY
❑ OWNER
❑ VACANT
❑ GR CONT. #
❑ BL CONT. #
METER SIZE GR RT#
LOCATION
COMPLETED BY
DEPOSIT AMOUNT
DATE PAID IN
REFUND DATE _
AMT REFUNDED _
AMT. APP. BILL
BIN SIZE NO, OF BINS
ISSUED BY
❑ ❑ ❑ ❑ ❑ ❑
11 COMPUTER FILE