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Work Activity Work Order pa9e 1 <br /> �o/s/zo�, ia:3i <br /> Issued By HMP HALE,MICHAEL P. <br /> Issued Department rw PUBLIC WORKS <br /> Date Issued 91612011 <br /> Fund t2o Account s Program eao Function tos Activiry st� <br /> Program <br /> TItIB SID[WALK REPLACEMENT 1631 RUCKER 840708671 � <br /> WOfk OfdB�NO 20112354 PfOJEC� Activity Type CORRECTIVE MAINTENANCE StBIUS CL <br /> Status �oisno�i Time �a:za Original WO __ Billing_ _ ___ _____ <br /> Customer Information <br /> Customer Name Customer ld <br /> Address Street <br /> Apartment No ��ty <br /> State Z�P <br /> Subdivision Change Map YIN <br /> Phone No ( > - Ext <br /> Second Phane ( 1 - Ext -- <br /> E-�dail Address ___ .__ __- _ _—_— <br /> Problem Informatian <br /> Address �g3� Street RUCKER AVE <br /> From Cross Streel <br /> To Cross Street <br /> City Z�P <br /> Subdivi=�cn Map Book Map Reference <br /> Problem <br /> Sub Problem <br /> Requesled By Date Requesled <br /> Agency Related Request <br /> IniGated From <br /> Utili�y Locate (USA) No Called Date Expiration Date <br /> Assignment Information <br /> Depl Priority Estimated Hours <br /> Crew <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Date To Be Comp Date <br /> Scheduled Date Scheduled �ime _ _ <br /> Route Roule Sequence <br /> Comments <br /> Action Taken BILL TO: PAULA MCCOULLOCK <br /> 1631 RUCKER AVE <br /> EVERETT,WA 98201 <br /> Recommended Action <br /> Approved By HMP HALE,MICHAEL P. .lOb COS�IflfOfft18tI0f1(Y/N)_ <br /> Start Date i � Time Date Compieted 9f612011 Permit No <br />