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Work Activity Work Order °a°` ' <br /> z;is/zo.z is:3i <br /> I�sued By SF2A SORGEN,ROBERT A. <br /> Issued Department Pw PUSLIC WORHS <br /> Date Issued 2reizoi2 <br /> Fund t2o Account s Program eao Function �oa Activity st� <br /> Program <br /> Tlfle SIDEWALK REPLACEMEfJT 3404 KROMER AVE <br /> WOfk OfdBf NO 20120358 PfOJBCf Activity Type CORRECTIVE MAINTENANCE St81U5 CL <br /> Status visizoi2 Time is2� Original WO Billing _ _ _ __ _ _ <br /> Customcr 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 /> Secand Phone ( 1 - Ext <br /> — – -- _ <br /> E-Mail Address _ - __ - <br /> Problem Information <br /> Address gqpq Street KROMERAVE <br /> From Cross Street <br /> To Cross Street <br /> City Zip <br /> Subdivision Map Book Ma{� Reference <br /> Problem <br /> Sub Problem <br /> Rer,uested By Date R2ques�ed <br /> Agency Related Request <br /> Initiated From <br /> Ulility Locate (USA) No Called Date Expiration Date <br />,` Assignment Information <br /> Dept Priority Estimated Hours <br /> Crew <br /> i Contractor <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 /> i <br /> Action Taken BILL TO: RICNARD AND t+1ARY OZMUN <br /> 3404 KROMER AVE <br /> � EVERETT,WA 98201 <br /> Recommended Actiun <br /> Approved By M}CC2 M1ICAULIFFE,KERRYN C. JOb COSt I�fOfri12ti0f1(Y/PJ) <br /> Sta�t Da�e � � Time Date Completed t�tm2o�z Pe�mit No <br />