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CITY dF EVERETT <br />DEPAFiTMENT OF PUBLiC LNORKS <br />UTtLiTY W�fiK ORDER <br />Uat�: ��'� �� WATER <br />O SEWER <br />O STORM <br />UTILITlES DIVIS'IOA <br />� <br />W.O. No. <br />1��i6 <br />Acct. No. �7 ti � � �f <br />, N,i �; .. .%'G�� (C ,i��.� ��� � <br />�57; Fo�; eD - tJ�TUtn�15 kEQ. �%omplaint No. <br />� SERVICE <br />O MAIN <br />❑ PUMP �TATION <br />❑ TREAYMENT <br />U RESERVOIR <br />❑ VALVE <br />❑ MAN HOLE <br />❑ CATCH BASIN <br />❑ DITCH <br />Location: _� � � ,Sr � �l���.7'�� /h(Ai�C-d- Wid 1�_ <br />W.O. Instructions: ��� � �i �'�Pc�/P -��f�� <br />ESTIMATED <br />Labor (hours) <br />Material (cost) <br />Equipment (cost) <br />ACTUAL <br />❑ M,4INTENANCE <br />Ci O?ERATION <br />� Ri=PAIR <br />O CONSTPUCTION <br />Labc�r (hours) . <br />Mate�rial (cost) . <br />Equipment (cost) : <br />SCHEDULING REQUESTED ,� . <br />USE CHARGE ACCOUNT NUMBER BELON/ FOR LABOR TIME SLIPS. ITcM17`E <br />LABOR, E�UIPMENT, AND MATERlALS ON ftEVERSE SIDE. , ` \` <br />Completion (Date): �� !' � �~% CostS <br />Charge Account Number: <br />Address: _ <br />Invoice No.: <br />i�as <br />,,' <br />:,t ,;�.:.,, ; <br />>, , <br />f ,��.+ <br />r:..� . <br />,';.;,: _ . <br />Charge Cost To (Namel: <br />ount:S Date: <br />