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Issued By saa <br />Issued DepartmentPw <br />Oate Issued 1 01512 0 7 5 <br />Fund �z0 <br />Program <br />��LIL ��� <br />_ ., , � <br />.�; _; :�:. ;� . , . .,�_ _� <br />Work Activity Work arder Pa�e ' <br />io�ia�zois �o:ai <br />SORGEN, ROBERT A. <br />PUBLIC WORKS <br />Account s Program sap Function �oa Activiry 6i� <br />Title SIDEWALK REPLACEh1ENT 25�7 HIGHLANU <br />Work Order No 20152276 Project <br />Status _ ionarzois Time +ai� Original WO <br />Customer Information <br />Customer Name <br />Address Street <br />Apartment No City <br />State Zip <br />Subdivision <br />Phone No ( ) • Ez1 <br />Second Phone ( ) - Ext <br />E-Mail Address <br />Problem Information <br />Address Street <br />From Cross Street <br />To Cross Street <br />City <br />Subdivision <br />Problem <br />Sub Problem <br />Requested By <br />Agency <br />Initiated From <br />Activiry Type CORRECTIVE MAINTENANC[ Sf2tU5 CL <br />Billing <br />Customer ld <br />Change Map Y�N <br />Map Book <br />UtiGty Locate (USA) No Called Date <br />Assignment Intormation <br />Dept <br />Crew <br />Contractor <br />Assigned To <br />Assigned By <br />Assigned Date To Be Comp Date <br />5cheduled Date Scheduled Time <br />Raute Route Sequence <br />Comments <br />Action Taken B�LL TO: JOHN 8 KIMBERLV DOOLIIILE <br />2507 H�:�MLAND AVE <br />EVERETT. WA 98207 <br />Recommended Action <br />Approved By HCJi HUTCNINSON, CHAD J. <br />Start Date � � Time <br />Zip <br />Map Reference <br />Date Requested <br />Related Request <br />Expiration Date <br />Prioriry <br />Estimated Hours <br />Job Costlnformation(YIN) <br />Date Completed �onrzot5 Permit No <br />! <br />