HomeMy WebLinkAbout11001 W. 41st AvenueZZLICII I -
v,-,
CUSTOMER NAME (PRINT) . ACTION TAKEN
) ~
/ A-
❑ O SHUTOFF
saeaFr. PPLIANCEOFF OWNEr7~ 7ENAN7 AGENTQ OrHER Q' ~❑BOTHAPPL:&METEROFF .
❑ METERSHUT OFP
- HAZARD -
CONOI710N 10 BE COPBECTED AS SHOWN BELOW CHEATES AN IMMEUTATE HAZAF :iHi UIP E U N BE T BACK IN
s~&~
°SERVICE UNTIL HEPNPS AND A THOHOUGH INSPECT16N HAVE BEEN MADE BY A QUAUFlEO CONTHACTOR. CONTACTYOUqwOQAL
~ BUILDINP DEORTMENTfOH CODE AND PEqMiT HEQUINEMENTS PPIOPTO PEflFOqMING PEPAIR WOBIG'
III
II
NqMEANDTYpEOFAPPtlM1GE
M Y:.
~
~
~
~
( -~C.
. '
~
C ':C . ✓L!
! C~ _
CONDITION T BE CORRECTED
~
FOR FURTHER INFORMATION, PHON
TACaOEOBY
IIME G~
DAIL
~
C OMER/OCW TSIGNANFE
DATE
flEL1TON5HIPFOCCUP :TOCUSTOMER