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GTY OF EVERETT wqiz�t <br /> " DEPI�RTMENT OF PUBLIC WORKS � � � � J <br /> • • Po ED �/�89 <br /> UTILITIES DIVISION � TuMMS 3/B�J <br /> . W.O. o. <br /> ' Acct No. ��5� �\ � <br /> Complaint No. <br /> UTIUTY WC�RK ORC`�R <br /> Date: � � �'� -�;� � WATER � SERVICE �l MAINTENANCE <br /> � <br /> ❑ SEWER O �NAIN , ❑ OPERATION <br /> ❑ STORM ❑ PUMP STATION ❑ REPAIR <br /> ❑ iREATMENT ❑ CONSTRUCTIOPJ <br /> ❑ RESERVOIR <br /> � � ❑ VALVE <br /> ��iH� �L`�,�n,��l � ❑ MAN HOLE <br /> ✓ �vci�i <br /> O CATCH BASIN <br /> �. <br /> ❑ DITCH <br /> Location: <br /> '7.Zo� ���5 �,�o � 21 S 3uy� ,��� <br /> ,� '' ��,.i�i v <br /> W.O. Instructions: T,7y,,G.S ��1 sc,Pl�i�-=� i'�oh � �-y T"� G• �S <br /> a�� � � :�y " s �9 <br /> �r�� - �-�- -� <br /> cQ/�� 4ta I,�'I <br /> �_�o� / l3/S9 <br /> �ru� f <br /> _ ;�Giv� �a,z r J�����/�9 <br /> ESTIMATED ACTUAL <br /> Labor(hours'; . Labor(hours) . <br /> Material (cost) . _ Material (cost) . <br /> Equipment (cost) : Equipment (cost) : .—_ <br /> SCHEDULING REQUESTED ___ <br /> USE CHARGE ACCOUNT NUMBER BELOW FOR LABOR TIIv1E SUPS. ITEMIZE <br /> LA90R, EQUIPMENT, AND MATERIALS ON REVERSE SIDE. <br /> Compietion (Date�: �'� � �'�`� � Cost:S . . <br /> Gharge Account Number: _Charge Cost To (Name): � <br /> Address: _ ��p� <br /> '` Invoice No.: Amount:$ Date: — <br /> K: . <br /> �ias <br />