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_. ��. _ . <br />_ � , <br />_.: ;oS�ec� /-90 <br />CITY OF EVERETT <br />DEPARTIIIEN � OF PUBLIC WORKS <br />UTILITIES DIVISION <br />,_ . . <br />L 6-Zg��.. <br />..�:;'.: i'S��a <br />``i. C". <br />9010 ; : <br />Acct No. � 7S� � � �� <br />f.;omplaint No. <br />UTILITY WORK ORCIER <br />pate: 1-'�`����� � WATER �SERVICE � MAINTENANCE <br />❑ SEWER O MAIN O OPERATION <br />❑ STORM ❑ FUMP STATION 0 REPAIR <br />❑ TREATMENT ❑ CONSTRUCTION <br />❑ RESERVOIR <br />❑ VALVE <br />O MAN HOLE <br />❑ GATCH BASIN UTL 9010 <br />❑ OITCH REn1E� <br />�Z-s-89 <br />Location:.__ �3D �'vP��,��� 1��5' <br />N/.O. Instructions: Rt �•'� �v�� ��N(� <br />ESTIMATED <br />Labor (hours) <br />Material (cost) <br />Equipment (cost) <br />SCHEDULING REQUESTED <br />ACTUAL� <br />Labor(hours) . <br />Material (cosl) . <br />Equipment (cost) : <br />USE CHARGE ACCOUNT NUMBER BELOW FOR LABOR TIME SLIPS. ITEMIZE <br />LABOR, EQUIPMENT, AND MATERIALS ON REVERSE SIDE. <br />Completion (Date): � �-�8 � � Cost:$ <br />Charge Account Number: <br />Address: <br />Invoice No.: <br />�ies <br />Charge Cost To (Name): <br />� <br />nt:S_ Date: <br />� <br />