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Work Activity Work Order P��� 1 <br /> a/�o/zois ;i:i9 <br /> ISSUEd BY SRA SORGEN,ROBERT A. <br /> Issued DepartmeniPw PUBLICWORKS <br /> Date Issued ai3�nots <br /> Fund tzo Account s Program eao Function �oe Activity 6i� <br /> Program <br /> TdlO SIDEWALK REPLACE�dENT 133t RUCKER <br /> lhbrk Order No 20151054 PfOJ2CI Activity Type CORRECTIVE tdNNTENANCE $121U5 CL <br /> Status ai3onot5 Time oe zo Original WO Billing_ _ __ _ _ <br /> Customer Information <br /> Customer Name Customer ld <br /> Address Streei <br /> Apartment No ��ry <br /> State ZiP <br /> Subdivision Change Map Y/N <br /> Phone No l 1 • Ext <br /> Secand Phone ( 1 • Ext — " <br /> E-Mail Address <br /> Problem Inforration <br /> Address Streel <br /> From Cross Sireet <br /> To Cross Street <br /> Ciry Z�P <br /> Suhdivision Adap Book Map Re(erence <br /> Pro6lem <br /> Sub Problem <br /> Requested By Date Requested <br /> Agency Relaled Request <br /> Initiated From <br /> Utihty Locale(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 Dale ___ ___ To Be Comp Dale <br /> Scheduled Date Scheduled Time _ _ <br /> Route Route Sequence <br /> Comments <br /> ACtlOtl T3kCI1 BILL TO: ROBERT DIETEL <br /> 13J1 RUCKER AVE <br /> EVERETT,WA 98201 <br /> Recommended Action <br /> Approved By MKC2 ���CAULIFFE,KGRRYN C Job Cost Information(Y/N)_ <br /> Start Date � r Time Date Completed 313112015 Permit No <br />