09-084.00 Consolidated Irrigation: Discovery Playground Water Service Installation
FROM Conwol 1 da-tad 1 rr i gat i orv <TUE)MAV 12 Z008 16: 30/ST. lE: 28/No. TS47T41236 P 2
CONSOLIDATED IRRIGATION DISTRICT NO. 1~,
N. 120 Greenacres Road
Greenacres, Washington 99016
NEW 3ERVICE WORK ORDER
Customer/Contractor:-L,+,-r nr KaK~ Iq11ej Account No.
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Mailing Address: 707 ~ • Si>R.aqv~ Au e- Dwelling: .
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~poCa we (/Q.~ ~t.~-S Wt,- 147b(,~ C o m m e r c i a 1:
Telephone: c?2,1 - I mo F--K t7zj- 1005 Duplex:
Name of Resident: Svxq~ vxc Address:
Pressure Area:CA
(City) (State) (Zi ) ~
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County Parcel No. ~/S~D~• qv7~ P1at01►0a6&vPv~~A RoU(--Lot No. Blk. No.
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Description of Work Requested: TN~II ~~~i ~o►~+r•~erc~~ wa, ~ ~R✓1e.~
2'~ ~jy ST . ~rv E~o
ESTIMATED CHARGES $~qCK2 AMOUNT OF DEPOSIT S
BAL. OF YEAR WATER CHGS ~
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ANNEXATION FEE
TOTAL ESTIMATED DEPOSIT ~-4 9cc-')-
I request water service from Consolidated Irrigation District and I
understand that the above stated estimated costs reflect the Estimated
Labor. Equipment. Material. Overhead. Taxes. and Capitalization Fee Charges
for the proposed contract work. I also understand that if the final costs
exceed the estimate. the balance will be due within thirty (30) days and
that if they are less I will receive a refund within thirty (30) days. I
further agree to abide by the Rules and Regulations as established by the
Board of Directors of Consolidated Irrigation District No. 19.
I also aqree that as a condition of receiving water service. prop.er access
to the water service will be 'provided and that no obstruction will be
constructed to interfere with inspection of or maintenance to the water
service. If so determined by the District, an obstruction to the water
service will be required to be removed or modified as a condition to
continued water service.
ature of Landowner
2~? Of Ags Date f) r Sign
ture of Representative
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