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� '� CITY OF EVERETT <br />. �•, <br />DEPARTMENT OF PUBLIC WORKS <br />UTILITIES DIVISION <br />�J 3 U : .� -5 <br />3i� U �o s'T�'v °�' <br />Ti>cnMs <br />,"`� 9052 <br />W.O. No. <br />Acct. No. � 7 S 1 I�j <br />Complaint No. __ _ <br />UTILITY WORK ORDER <br />Date: (�"z z" y� .� WATER ICiSERVICE � MAINTENANCE <br />❑ SEWER ❑ MAIN O OPERATION <br />❑ STORM ❑ PUMP 3TATIUN ❑ REPAIR <br />O TREATMENT ❑ CO�SIRUCTICN <br />❑ RESERVOIR <br />❑ VALVE <br />❑ MAN HOLE <br />❑ CATCH BASIN <br />❑ DITCH <br />Location: �G�����!�%Q� /T�e- — <br />ESTIMATED <br />Labor (hours) . <br />Material (cosq . <br />Equipment (cost) : <br />ACTUAL <br />Labor (hours) . <br />Material (cost) . <br />Equipment (cost) : <br />SCHEDULING REQUESTED <br />USE CHARGE ACCOUNT NUMBER BELOW FOR LABOR TIME SLIPS. ITEMIZE <br />LASOR, EQUIPMENT, tiND MATERIALS ON REVERSE SIDE. <br />Completion (Date): _—�'23� � � _Cosh$ _ <br />Charge Account Number: <br />Address: _ — <br />Invoice Na: _ <br />!ias <br />Charge Cost To (Name): <br />unt:S <br />