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1Mork Activity Work Order pagE 1 <br /> 6/26/2012 10:04 <br /> Issued By HMP HALE,MICHAEL P. <br /> Issued Department Pw PUBLIC WORKS <br /> Date Issued s�zoizo�2 Activi <br /> Fund tza Account ; Program aao Function �a6 ry s�1 <br /> Program <br /> Title SIDEWALK REPLACEMENT 1902 LOMBARD AVE <br /> Work Order No 20121011 Project Activity Type CORRECTIVE MAINTENANCE St8�U5 CL <br /> Status sizeizoiz Time os:5e Original WO Billing <br /> Customer Information Customer id <br /> Customer Name <br /> Address Street <br /> Apartment No City <br /> State Z�p <br /> Subdivision Change Map YIN <br /> Phone �o ( ) • Ext <br /> Second Phone ( ) - Ext <br /> E-Mail Address -- ------- --- <br /> Problem Information <br /> Address �gpy Street LOMBARD AVE <br /> From Cross Street <br /> To Cross Street <br /> City Zip <br /> Subdivision Map Book Map Refe;ence <br /> Problem <br /> Sub Problem Date Requested <br /> Requested By Related Request <br /> Agency <br /> Initiated From <br /> Utility Locate (USA) No Called Date Expiration Date <br /> Assignment Information <br /> Dept Priority Estimated Hours <br /> Crew <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Date ___ To 8e Comp Date _ <br /> Scheduled Date Scheduled Time ___ <br /> Route Route Sequence <br /> Comments <br /> ActiOnTaken gILLTO: NIKKIOKU <br /> 1902 LOMBARD AVE <br /> EVERETT,WA 98201 <br /> Recommended Action <br /> Approved By scs BISNETT,GREGG S. JOb COSt ItlfOff112�1Of1(YIN� _ <br /> Start Date i � Time Date Completed 6�ztnotz Permit No <br />