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Work Activity Work �3rder page 1 <br /> 10/29/2013 15:40 <br /> ISSU2d BY SRA SORGEN,ROBERT A. <br /> Issued Department Pw PUBLIC WORKS <br /> Date Issued 1012912013 <br /> Fund �2o Account s Program ano Function toe Activiry ett <br /> Program <br /> Title SIDEWALK REPLACEMENT 3525 NORTON AVE <br /> Work Order No 20133514 PfOJ2Cf Activity Type CORRECTIVE MAINTENANCE St8tU5 CL <br /> S�8IU5 10I29I2073 Tlfl'IB 15:30 �f19if191 W� . _ _ Bll�lfl9 _ __ _ <br /> Customer 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 ( 1 - Ext _ <br /> Second Phone ( > - Ext <br /> E-Mail Address _—___--___ -- <br /> ProL•lem Information <br /> Address 3525 Street NORTON AVE <br /> From Cross Street <br /> To Cross Street <br /> City Zip <br /> Subdivision Map Book Map Reference <br /> Problem <br /> Sub Problem <br /> Requested By Date Requested <br /> Agency Related Request <br /> Initiated From <br /> Utility locate (USA) No Called Date Expiration Date <br /> Assignment Information <br /> Dept Priority 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 /> Comments <br /> Ac'ion Taken g�LL TO: MATTHEW HUBBARD <br /> 7525 NORTON AVE <br /> EVERETT,WA 58201 <br /> Recommended Action <br /> Approved By MKC2 MCAULIFFE, KERRYN C. JOb COSI Ifl(Offll8tl0f1(Y/N) <br /> Start Date I i Time Date Completed amzot� Permit No <br />