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<br />• <br /> <br /> <br /> <br />CONTRACTOR/OWNER ~, ~ w~-L~~~-~- <br />LEGAL DESCRIPTION ~ ! pCIG_ ~ ,Z ~_ ~~°~"~ •7 ~~ L •P <br />~ 1 A ~ :. .. <br />• JOB ADDRESS ~ ~~ ~. !"( t A~ ~.~ ~..'1. ~ ~'.~.+ . .~ `~~`I' .J '' . ;~ _ .~ . <br />i, . <br />EXTE~S~ON AGREEi~1ENT SIGNED (DATE).' ~ ( oy ~, .,,•.. ~~ i1,' 1 <br />;; ~~ - --rtr-t <br />DEPOSIT $ ~ ~~ . ... RECEIPT ~ S~1S~ ~ - . <br />WORK TO BE DONE BY:~ CITY CONTRACTOR/OWNER BID <br />` WATER EXTENSION ~ ~ ~.,. ~~ .FEET ,DATE COMPLETED ~ ~ •~ <br />Total Material Cost $ ~ - . <br />' ~~ Total Labor Cost $ ~~~ ~ ~~~ •- ~ ~ -•~ <br />l•j'~'o Total Equipment Cost$ __ _ ' <br />'Total Extension Cost$ ~ .r <br />- ~ ,l - <br />~_ SEWER EXTENSION ~ '••']~j ~~~~. FEET DATE, COMPLETED; ~1~ `~ ~ ' <br />lTotal Material Cost $ '"' <br />-Total Labor Cost -.' $ - ,. .-.... ....... ..... .. <br />Total Equipment Cost $ "' '~-' _ <br />Total Extension Cost $ .5~~ , ~ " ~ "' ' ~ " ' <br />,, <br />- ENGINEERING FEES $ <br />1 ~ . <br />TOTAL WATER AND/OR SEWER EXTENSION COST ~ , <br />.$ <br />WATER ACCOUNT !i ~ SEWER ACCOUNT' ~ Z,-8(3-~f <br />INSPECTEli BY DATE <br />CODE E.If":~RCEMENT APPROVAL, _ _ DATE ~ --'~~~ • <br />COMMENTS <br />' , <br /> <br />. _ <br /> <br />