|
(" , ' ` CITY OF EVERETT :
<br /> ' DEPARTMENTOF.PUBLIC.WORKS F3° SO�
<br /> � _ ,, .
<br /> ,�'.; '�' � . UTILITIES DIVI$ION, ' �
<br /> . . a,;Tu�Ms w o. Na :. : ,
<br /> 5�9�Tp ;,ZG �'`� Acct�Na L7 �� 71 �:
<br /> r �. _ .. � ,.20. . . _ ,
<br /> y � a'' .2p� . 2� 5� Complamt No . i ;
<br /> UTILITY WORK ORDER C . . : . ' . ;
<br /> � �/ '.�� , oe7i� ��o� � ,:��,r-. ;
<br /> ��Date .�10��� �W WATER . � SERVICE i�7 MA(NTENANCE`.'""`� - ;,
<br /> �' : . ❑ .SEWER ❑ MAIN .' ❑ OFERATION �,..:. �z •:a. �
<br /> : . . ,. ,.
<br /> ls` , . 0 STORM ❑. PUMP STATION ❑. REPAI� �' ;., � j
<br /> , �- : :. ,.. � . . , • ,
<br /> ; •.> . -•:
<br /> .....
<br /> , ;4 ;� `. „ - ❑ TREATMENT. � :❑ CON�STRUCTJONf � ��•
<br /> � ❑ RESERVOIR - "� �
<br /> . - , �� .. _
<br /> ! `, • O VALVE : ��: , '.:.:.
<br /> . .. ❑ MAN HOLE f` �
<br /> ::� -
<br /> ' Q�I ���� (� ❑ CATCH BASIN . �.`„
<br /> • � / f � ��'(iy� `�� ❑ DITCH , ' .
<br /> � .
<br /> Location: �UI�TU?/ 5 I , I i r w�Tfi �� P�ic i��� . . . . - . :_`::._
<br /> W.O. Instructions:' ''t+?N,YS Fi-� sf�l�'i�C.S �•r�iry � �� ����Ai,•Y � ..
<br /> , _ . . T.� � " ps; �s-,.i��' �Y�U �1�?rlyDvy �� '' GT �r,+„y _.. .
<br /> . 't ;;.
<br /> � � . . ._.. .. .
<br /> � ; �,,.�, :... . _,.. �iz.--__�i9c:f-:` ` i9/l 2c-T . .
<br /> .-- "" ;;,
<br /> . . j
<br /> . , . . .. . . . . . .e . ��r; �yr-'='•• .
<br /> c . �..
<br /> I . - . " � _ ' . (
<br /> ' ' � M .
<br /> �
<br /> �
<br /> ` � . . . . . . . ' '
<br /> � . . � . .. . ..1�. yA:_ ..
<br /> . . . . . ' . .tti
<br /> � . . ... ��: '� . ' � �... - :"..�.,. � . i: _
<br /> ESTIMATED ': ' ACTUAL �
<br /> i ' . -.-Labo'r(hours) . Labor(hours) . �'�� �
<br /> � ,. • : . . .� ' . �� �T.:
<br /> Matenal (cost) • Matenal (cosq „ :
<br /> � ',Equipment�(cost) Equipment_(cost) � � r` .^� �
<br /> i . . -
<br /> i � SCHEDULING.REQUESTED t� -
<br /> �-'. . '-: : .. . : . � � .' .-. . �.. . :.. . .. � - � .'pr r�. �,i�:._
<br /> , � USE'CHARGE ACCOUNT NUMBER BELOW.FOR LABOR TIME SLIPS. ITEMIZE ^ �;� ;_ .°�,,.
<br /> , �LABOR EQUIPMENT, AND MATERIALS ON REVERSE SIDE. ' �;; r �
<br /> ` / c , . . . , . .. r .i..�.� � a.n .: � c..
<br /> � �r ., ;_ _ ,.; , �. _ r ,�.�.i� }.
<br /> '. .�—tii�q c`osts ^
<br /> . � GompleUon (Date) , , , 9 , ��
<br /> i
<br /> �} 'T!�b�f �; �l . :� ., . YL . :J�- :. . . � �,��j'Po � �
<br /> ��S . 1
<br /> `: i iCha�ge Acco'unt Numtier � Charge Cost To(Name). • •' �' �"
<br /> � y1 - . _ .. . . . � J: h. ��:.
<br /> � Address ,� .. . . . Zip
<br /> .:._ .,...;., . � . -
<br /> �\ tilnvoice No - Amount $ ' ' Date , x'' . —
<br /> .
<br /> �:
<br /> - ,.;;: r . . _ . • _ . . - . ' . ' _ .. .'
<br /> iies : .: - .:-� .
<br /> ,:
<br />
|