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�. <br />CITY OF EVERETT <br />DEPARTMENT OF PUBLIC WORKS <br />UTILITIES DIVISION <br />F�-�- 5 <br />TOSi E�— ���� <br />UTILITY WORK ORDER i�lo T�IP'I i�I � <br />Date: LyS" �� y l� WATER <br />❑ SEWER <br />O STORM <br />Location: <br />W.O. Instructions: <br />ESTIMATED <br />Labor (hours) . <br />Material (cost) . <br />Equipment (cost) : <br />`p� SERVICE <br />❑ MAIN <br />❑ PUMP STATION <br />❑ TREATMENT <br />❑ RESERVOIR <br />❑ VALVE <br />❑ MAN HOLG <br />❑ CATCH BASIN <br />❑ DITCH <br />�� <br />ACTUAL <br />ti,,�J eAOD <br />W.O. No. <br />,a��t No. � � T� r q <br />Complaint No. <br />❑ MAINTENANCE <br />❑ OPERATION <br />� REPAIR <br />❑ CONSTRUCTION <br />Labor (hours) . <br />Material (cost) . <br />Equipment (cost) : <br />� SCHEDULING REQUESTED <br />USE CHARGE ACCOUNT NUMBER BELOW FUR LAFiOR TIME SLIPS. ITEMIZE <br />LA[30R, EQUIPMENT, AND MATERIALS ON REVERSE SIDE. •;�:p:;,. . <br />: '�il �i� Cost:$, • <br />q : <br />. <br />Completion (Date): J ' <br />., _ ; ,:6 <br />'Charge Account Number. Charge Cost To (Name): <br />Address.. � � . - _ --- .. `- Zip _. <br />_ ... .....- -- ,_,. _. .. ... _ .. _ <br />Invoice No.: " <br />. AmounCS ' Date: . � <br />1 /CS + <br />