HomeMy WebLinkAboutWORK ORDER - 04-00344 - 602 Cook St - New SFRAPPLICATION FOR REXBURG CITY SERVICE
NAME
ADDRESS 3 � �� Z �� eC. 2:ny J?Ije I, -
PLUMBER �Lylv-�//tl-
PROPERTY
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 DATE
NAME A/7 /7. �)f SERVICE ADDRESS
MAILINGADDRESS 3699 illi ZSa LCA v26;epp
1/I9-6 %—/) ?3 VV
OWNER PHONE __�/`9C.r% NO. OF PEOPLE
ADDRESS
EMPLOYER OR RELATIVE
COMMENTS
SS#
SIGNATURE
❑ IN
❑ READ
RENTING
❑ ON
❑ RE -READ
❑ BUYING
❑ OUT
❑ CHECK LEAK
❑ SELLING
❑ OFF
❑ WTR.SWR ONLY
❑ OWNER
❑ VACANT
❑ GR CONT #
❑ BL CONT. #
AMC" 17a.N7.TTy
DEPOSIT AMOUNT
DATE PAID IN
REFUND DATE
AMT REFUNDED
AMT. APP. BILL
METER SIZE GR RT# BIN SIZE NO. OF BINS
LOCATION
COMPLETED BY ISSUED BY 0 compvrER FILE