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�/ UtiGties Dirision, 32U0 Cedar Strcet <br />L•.eerett�l'A 952U1 <br />a2��'�?-SS00 <br />Feceipt - <br />Cost of 1Vork Order <br />�__ Cost of Servicc Ordcr � % ' ? : � �? <br />ContadPcrson r ��� 11 C�tuJ'vE.�� <br />--T / <br />Requested By ���r-+'� ��'- L9]1� U P�.___ � -- <br />Properh�Owner(namc) i-lCC=��'�� .iUN`T117r•1TS <br />Chuge Cost to (name if dif(erent lhan o�+-ner) _ <br />Address 1`) lG� IC�T��! `^�' Cih' <br />Installarion Loca�on <br />�� G� �'µ� a"� <br />L�stallauon t�•pe/desuiption/size/etc. _'�c:-r�' `M.� <br />_�-/1�i,.�y C1��C-itGu.i+�[.c�� <br />(J�' The follo���ing estim�te is based upon the li <br />materials, restoration, and fuial ltoo�-up. <br />Datc Pai�i __,�--- <br />11'erk Order� <br />Service Order � __ <br />1'elephonen �I�%i5 -jj�i'`f'7/fF <br />llate of Requcst � "�l ' �� <br />1� LC: <br />P� ���,i•e 7� <br />ZiF <br />�T <br />�C'� <br />q `3.:C � — <br />Divisiun rrovidin� all lab� r, equipm�nt, <br />Please notifv the Citv of Gverett Utilities Dicision 10 ��•orkin�� dat�s in ad� �nce of recLired_installation <br />date to allo�v for schedulin� and parts vrocurement <br />:\lienet�er lhe eslimated cosl is not sufficient Io cocer lhe lotal expense for labor, material, equirment tenlal and <br />adminislrati�'e costs, the deficit shall Ue char�ed to the property for �vhich such in�tallalion n'as made and the <br />o�ener lhercof, and pro� ided further, thal any excess p�}'ment shall hc rehirned lo Q�e p�i's��'i'F�)'"'� tOr thc <br />installation. <br />*Deposil musl be paid prior to ordering parls or scheduling ���ork. <br />"Afust ha� c���1id Public �Vorks Pcrniit Heforc �+�ork can Uc perfom�cd. <br />IVATER �1-IETI�RS 3„ <br />�i������t <br />1_abor and I3cnctits <br />Equipmcnt Rent�l <br />Ta� <br />1' <br />, 7�' --- <br />��� � ' — <br />�tr-� ,�_ <br />S�-- <br />•, ,- <br />1 <br />T' <br />ci: 31dg. Pcrntit l�cni� r <br />�t,�ti �.�,it�•r <br />Gor�3un 11'ilnc�r <br />\tatt 1�'elbom <br />\fiF.c 4\�ard <br />I:andc AC��n <br />1'�ul NcF����• <br />Restor;�tion �/ — -- <br />�'ar:\L 1Y�� �Z..O� -- � <br />Prepared U�: /��i'KJ �(,C�� Datc Lstimate Preparcd _ L_. ��'—� ----- <br />.�ccepted hy: Representing ----- <br />IiS'fID1:�'�E GOOD ROK fi �iONTIIS <br />$V"-Com�n, n'.:L^nmf Crs� ciA?014A 1�.f 1 <br />