HomeMy WebLinkAboutWORK ORDER - 04-00380 - 364 Mariah Ave - New SFRAPPLICATION FOR REXBURG CITY SERVICE
NAME 'I l6tV+
ADDRESS 3
PLUMBER -5 3
PROPERTY OWNEF
WATER SERVICE:
Type Size
Water Connect......
f
Water Meter .......;
Meter Box .........
f
Ring 8 Lid.........
i
Curb Stop .........
i
Setter ..............
i
Sewer Connect .....
TOTAL............s
In City Out of City
Storm Drains — $
APPROVED BY
WORK ORDER
ACC# RT# PHONE Q?-Wf5' EFFECTIVE DATE DATE
NAME 2t "esz SERVICE ADDRESS
MAILING ADDRESS
OWNER k wv7l�„
ADDRESS
EMPLOYER OR RELATIVE
COMMENTS
SS#
❑ IN
❑ READ
❑ ON
❑ RE -READ
❑ OUT
❑ CHECK LEAK
❑ OFF
❑ WTR.SWR ONLY
❑ VACANT
❑ GR CONT. #
METER SIZE
GR RT# _
LOCATION
COMPLETED
BY
PHONE
SIGNATURE
❑ RENTING
❑ BUYING
❑ SELLING
❑ OWNER
❑ BL CONT. #
_ NO. OF PEOPLE
yy0
WORKPHONE
DEPOSIT AMOUNT
DATE PAID IN
REFUND DATE _
AMT REFUNDED _
AMT. APP. BILL
BIN SIZE NO. OF BINS
ISSUED BY
❑ COMPUTER RLE