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CITY OF EVERETT i.,o '�::,;:•� .-.==• %%%' y <br /> DEPARTMENT OF PUBLIC WORKS <br /> l3TILITIES DIVISIOR <br /> W.O. No. _ <br /> � � _ � Acct No. 1 ; � I I �/ <br /> ... � —'� <br /> Complaint No. <br /> UTILI'PY WORK I�RD�R <br /> Date: �'� � WATER � SERVICE � MAI;dTENANCE <br /> ❑ gFyVER ❑ MAIN ❑ OPtRATION <br /> ❑ STORM ❑ PUMr' STATION G REPAIh <br /> ❑ TREATMENT ❑ CONSTRUCTION <br /> ❑ RESERVOIR <br /> ❑ VA�VE <br /> / ❑ MAN HOLE <br /> v�oZ�S�����% CG�� ❑ CATCH BASIN <br /> ` ❑ DITCH <br /> �ocation: � '> - ;n c K Sc ✓ -- <br /> W.C. Instructions: .—� o�'� J-'!�A'"�E'P ita�6-t�� d- g,G�✓'�+�u' itrFil�,�f RC x <br /> 1N ��'l� C �-yc�E-r� �Ni�6x WiTN F�'L�- SrGz� ! � 0 <br /> ESTIMATED ACTUAL __ <br /> Labor (hours) . Labor(hours) . <br /> Material (cost) . Material (cost) . <br /> Equipmant {cost) : — Equipment (cost) : <br /> ;CHEDUL'NG REQUESTED <br /> USE CHARGE ACCOUNT NUMBER BELOW FOR LABOR TIME SLIPS. ITEMIZE <br /> �ABOR, EQUIPMENT, AND MATERIALS ON REVERSE SIDE. <br /> Completion (DateE Cost:S — <br /> Charge Account Number. Charge Cost To (Name�: �'��l« "''�+��`"'° ` � <br /> Address: <br /> i r t � rifr n r"��c�� L r vc �JG�T w�� H _ Zip: �1 �7�'" <br /> Invoice No.: <br /> Amount:S Date: <br />