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Work Activity Work Order ��9� 1 <br /> ?/17/2014 11:55 <br /> Issued By� sru SORGEN,ROBERT A. <br /> Issued Department aw PUBLIC WORKS <br /> Date Issued 817 412 01 5 <br /> Fund uo Account s Program eao Funclion �oa Activiry s» <br /> Program <br /> Tit12 SIDEWALK REPLACEtdENT 2216 PINE ST <br /> WOfk O(dBf NO z0�4Z963 PfOjEC� ACiiVlry Typ2 CORRECTIVE MAINTENANCE StBIuS CL <br /> Status Qn�izota Time tis3 Original WG Billing _ _ ___ <br /> Customer Information <br /> Customer Name Customer ld <br /> Address izie SffEEf PINE ST <br /> Apartment No City <br /> State Zip <br /> Subdivision Change Map YIN <br /> Phone No ( 1 • Ext <br /> Second Phone � > • Ext — — <br /> E-Mail Address <br /> Problem Information <br /> Address Street <br /> From Cross Street <br /> To Cross Street <br /> City Zip <br /> Subdivision Map Book Map Reference <br /> Probiem <br /> Sub Problem <br /> Requested By Date Requested <br /> Agency Reialed Request <br /> Initiated From <br /> Utility Locate (USA) No Called Date Expiration Date <br /> Assignment Information <br /> Dept Prionty Estimated Hours <br /> Crew <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Date _ ____ To Be Comp Date <br /> Scheduled Date Scheduled Time <br /> Route Route Sequence <br /> Commenis <br /> Action Taken BILI TO: JEFF HARRIS <br /> 2908 19TH ST <br /> EVERETT,WA 9820'I <br /> Recommended Action <br /> Approved By eos BREKHUS, DENNIS B JOb COSt If1I0ffT12GOf1(YIN) <br /> Start Date � i Time Date Completed enano�a Permit No <br />