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Work Activity Work Order <br />Page 1 <br />ia/s/zoii ia:z� <br />ISSU2d By HMP HALE, MICHAEL P. <br />Issued Department Pw PUBLIC WORKS <br />Date Issued en2izott <br />Fund tzo Account 5 Program eno Function toa Activity stt <br />Program <br />Title SIDEWALK REPIACEMENT 901 RUCKER AVE 840108611 <br />Work Order No 20112352 PfOJ@Cf Activity Type CORRECTIVE MAINTENANCE <br />SlBiUS 10I512017 TIfT10 13:38 Of191f181W0 __Bllllfl9 _ _ _ ___ _ _ _. <br />Customer Information <br />Customer Name <br />Address Street <br />Apartment No ��ry <br />State Z�P <br />Subdivision <br />Phone No ( ) • Ext <br />Second Phone ( ) • Ext <br />E-Mail Address <br />Problem Information <br />Address gp� Street RUCKER AVE <br />From Cross Street <br />To Cross Street <br />City <br />Subdivision <br />Problem <br />Sub Problem <br />Requested By <br />Agency <br />Initiated From <br />Utility Locate (USA) No <br />Assignment Information <br />Dept <br />Crew <br />Contractor <br />Assigned To <br />A ned B <br />Map Book <br />Called Date <br />ssig y To Be Comp Date <br />Assigned Date _ __ <br />Scheduled Da?e Scheduled Tirne <br />Route Route Sequence <br />Comments <br />Action Taken 81LL TO: RAYMOND MCINTOSH <br />901 RUCKER AVE <br />EVERETT, WA 98201 <br />Customer ld <br />Change Map YIN <br />Zip <br />Map Reference <br />Date Requested <br />Related Request <br />Expiration Date <br />Priority <br />Estimated Hours <br />SfatUS CL <br />Recommended Action <br />Approved By HMP HALH, M11ICHAEL P. JOb COSt It1(OffT18fI0f1(YIN) _ <br />Start Date � � Time Date Completed e�xaizott Permit No <br />