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Faae 1 <br /> Work Activity Work Grder q,lY,�o„ 1,:02 <br /> ISSl10dBy HW � HUSBY,LANCEJ. <br /> Issued Department Pw PUBLIC WORKS <br /> Date Issued va�zoia Account s ' 9 Function i�s Activity 675 <br /> Fund ao� ro ram �to <br /> Program <br /> TItl2 REPAIR.75 INCH 11119 3RD AVE SE 7101196%5 <br /> Work Order No 20130109 PfOfBCf Activity Type CORRECTIVE MAINTENANCE Sf81U5 CL <br /> Sf8iU5 1l312073 TIR12 19:36 �fl If101 WO 201207G2 __81111f19 _ _. __ _ . _ _ -- . --- <br /> — — ----- -- ---9 --- <br /> Customer Information Customer ld <br /> Customer Name <br /> Address Street <br /> Apartment No City <br /> State Z�P <br /> Subdivision Change Map Y/N <br /> Phone No ( ) • Ext _ - ------. — — <br /> Second Phone � 1 • Ext <br /> E-Mail Address ----- --------- — <br /> Problem Information <br /> Address �i��g Street 3RDAVESE <br /> From Cross Street <br /> To Cross Street ZiP <br /> City EVERETT <br /> Subdivision Map Book Map Re(erence <br /> Problem <br /> Sub Probiem Date Requested <br /> Requested By Related Request <br /> Agenq� <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 To Be Comp Date <br /> Assigned Date -- <br /> Scheduled Date Scheduled Time _ __ <br /> Route Route Sequence <br /> Comments <br /> Action Taken UNLOOPED SERVICE INSTALLED.751NCH SETTER,BOX,JUMPER AND MOVE APPROX.15 FEET <br /> EAST.CAME BACK AND MOVED SERVICE BACK.PlEASE CHARGE TIME AND MATERIALS TO: <br /> LIFT STATION M24 EMERGENCY FOftCEMAIN REFL-CONST M20120762. <br /> Recommended Action <br /> Approved By wo� �'EAVER, oEAN� Job Cost I�formation(YIN) _ <br /> St�rt Date i � <br /> Time Date Completed s�sizota Permit No <br />