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_ Y : <br /> Work Activity Work Order P°�n 1 <br /> 9/13/?O11 15:28 <br /> ISSU2d By � CSG CAVANAH,SHANF G. <br /> Issued Department Pw PUE3LIC WORKS <br /> Date Issued enai2o» <br /> Fund ao� Account 5 Program �to Function »y Activity 675 <br /> Program <br /> Tille REPAIR.75 INCH 26 E INTERCITY AVE 710119675 <br /> WOfk OfdBf NO 20111837 PfOJ2CI Activity Type CORRFCTIVE MAINTENANCE StB�US CL <br /> $18W5 &I1812011 TIff10 15:55 Of191f18I WO Bllllfl9 _ __ _ _ _ _ _ ___. _____ . <br /> Customer Information <br /> Customer Name Customer ld <br /> Address Street <br /> Apartment No City <br /> State Z�P <br /> Subdivision Change Map Y/N <br /> Phone No ( ) - Ext _ <br /> Second Phone ( ) - Ext -- <br /> E-Mail Address _ _ <br /> Problem Information <br /> Address yg Street EINTERCITYAVE <br /> From Cross Street <br /> To Cross Slreet <br /> City Zip <br /> Subdivision Map Book Map Reference <br /> Problem <br /> Sub Problem <br /> Requested By Date Requested <br /> Agency Related Request <br /> Initiated From <br /> Utility Locate (USA) No Called Date Expiration Date <br /> Assignment Information <br /> Dept Priority Estimated Hours <br /> Crew <br /> Contracror <br /> Assigned To <br /> Assigned By <br /> Assigned Date To Be Comp Date <br /> Scheduled Date _ Scheduled Time <br /> Route Route Sequence <br /> Comments <br /> i1CtIo0 T8ke0 REPAIRED BROKEN SERVIC[. <br /> RECORIff1C17C10d AC11011 BILL TO: SMOOTS UEVELOPMENT INC. <br /> 1306 BONNEVILLF AVE SUITE D <br /> SNOHOMISH,WA 98290 <br /> Approved !3y WDL WEAVER,DEAN L. �Ob COS��flfOff118110f1(I�/N� _ <br /> Start Date i � Time Date Completed ansizo�i Permit No <br />