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G <br />Servke Reqrat k <br />.. <br />City of Evarett Work Activi4y <br />Work <br />��Tf{' <br />:;'', ;: <br />� Into � <br />'. . ✓; '. : �i' P.."`- <br />� �yr� <br />_ . :.�.'.F�i <br />w .T. F: <br />' :� <br />- :'!.,,: <br />Datels�aed '� /i��R/L g >;`:..,: <br />,. ., <br />Issned By GA �ARy f✓.L/l,v . : . <br />!nlrialr Fu!! naine <br />Fand :/O / � Prognm rf/D F�mcdon // g Activiry �%�$ .•:' <br />Job Cast No �� � r_� - C� ProJect No. <br />Title �LacATL j'�/ SG.C!//GG .�oX � <br />� r►V`l�iE'��/�'�r, • • �' � • �, <br />. <br />Problem Informadon <br />Addreas Prcdirection Street Stmt Type Postd(rectlo� <br />,5�, � . �f!/��,so.v _ ST . a ;� <br />. . .. . . . . . .."��M <br />CIry � ' <br />•Ijnoe"Evwtlt"Jpee�whichClry• • . <br />' Structurc/Equipment Informa8ou <br />• : �, <br />StructlEquip Type AS�I/C Problem • <br />Struct/Equip Pio /�� O �S . Sub Problem � � . I . � <br />Strrrcture/Equipmenf type when applicable <br />� Feet �� Description -1 <br />Comments I ����� BOX <br />Bold Type � Mandator relds to be populated <br />/talic a Optionalfrelds <br />FORMS:WRKACCVI'3 (CM Oi/16199) <br />