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CITY OF EVERETT <br />DEPARTMENT OF PUBLIC WORKS <br />UTlLITIES DIVISION <br />��'c� ��D I �'� <br />� ' ily <br />UTILITY WORK ORDER <br />Date: r- ��' �' ti"' 7� WATER <br />❑ SEWER <br />❑ STORM <br />i <br />t�� SEkV�CE <br />❑ MAIN <br />❑ PUMP STATION <br />❑ TREATMENT <br />❑ RESERVOIR <br />❑ VALVE <br />❑ MAN HOl_E <br />❑ CATCH BASIN <br />❑ DITCH � <br />:� <br />-r <br />.. , ,. , <br />. , ; .- <br />�C b --z� -'> <br />,�� <br />W.O. IVo. <br />Acct. No. � %,'; I1 '1 <br />Complaint No. <br />� MAIN'fENANCE <br />❑ OPERATIOId <br />❑ REPAIN <br />❑ CONE�TRUCiION <br />� <br />Location: .� � � ���n��r��,�y �� . <br />i <br />W.O. Instructions: Y� I L %/ •�� '�/, � j i _ <br />i r° <br />i <br />� <br />ESTIMATED <br />Labor (hours) <br />M�terial (cost) <br />I Equipment {cost) <br />.:. ;� ; i- <br />�. � . <br />,i ��,,; ^:, ..., ; �� <br />. ;,:, <br />.� j • <br />+r. : <br />f;` '' � ��l, ��� <br />. <br />' i4' r, <br />' � , �. / <br />•:i�' 1 . <br />ACTUAL !:'� � '" � <br />Labor(hoursj, . <br />Material (cost) . <br />Equipment (cost) : <br />1 <br />SCHEDULING REQUESTED <br />USE CHFlRGE ACCOUNT NUIv18ER BELOW FOR LABOR TIME SLIPS. ITEMIZE <br />LA80R, I:QUiPMENT, AND MATERIALS ON REVERSE SIDE. _. . ,, <br />Completion (Date�: �� `��� .—Cost:S <br />Charge Account Number: _Charge Cost To (Name): <br />Address —Z�p� <br />Invoice No.: Amount:S _Date: <br />iins <br />0 <br />� <br />