|
� ' . �� ` . .. CITY OF EVERETT
<br /> i� R.
<br /> . i''� � .r.r ; r.- `DEPARTMENT OF PUBLIC WORKS . . . , i`��' ; �O�O r
<br /> .� r5 � _ S � '� ,.
<br /> ; S ' ' ' UTILITIES DIVISION i .. ; $ t,h �
<br /> yt f:, �� , . - 'W No' r �' )
<br /> Y Hi +'. r.c '. . . - � ^t.^ , _ ..O y .�;. L�tii�l f
<br /> ' I l'' tC �^ { . .
<br /> . . J. { {` 1 L'.l . - . /V�( .� '. ._ f � �
<br /> � <n r�� � :]i J ♦ .� , . .. �� .��� / � ACCI. NO �i� S I I' y
<br /> ! , J . ', . . - � .. � ... . `. � �.
<br /> � j " ,,� 5�8c� �STED �' TUrItMS Complaint No } .. � _
<br /> ` � UTILITY WORK dRDER � . , Y,,
<br /> i �. i : � � _. . , /'. _" _ . . / . :. ;. . �' L r 5�5. :!� �f � : ; .t �� :.
<br /> I Date ° 3l�'� �u �WATER �C�" SERVICE :� MAINTENANCE ` ` ;
<br /> � SEWER ❑ MAIN ` ' ❑ OPERqTION�' ` � �',� '
<br /> •� � , :; , :
<br /> � .. O••STORM .. ❑ PUM� STATION : �7 � REPAIR � +� ;:, , „
<br /> �1 r j i � � .... .. . . .. .}. � . :.. . ,
<br /> � T.'. 1 .. .. f 1 .
<br /> `_ � s; i , � ❑ 7REATMENT ❑ CONSTRUCTION ,
<br /> ❑ RESERVOIR : ' ` ` �
<br /> r � -
<br /> ' • ❑ VALVE ��_ w. ' ' ,
<br /> / , r ,
<br /> , J� � , �J�j� ❑ MAN HOLE ' �,`r ' .
<br /> ��� �"��� �/ ❑ CATCH BASIN ' -
<br /> �.
<br /> ❑ DITCH
<br /> / l� •-_ �'y `.
<br /> Location �� � ��) �� I � - LI b''t
<br /> :�:.:_ ,
<br /> W.O. Instructions: G vyyE G S�n'{'i LG S TJ /l�$W �'i�� i,v y �) fr�—
<br /> 'K, � � s �Pvi r� s n�r FcR.:� n,�
<br /> - � 3- 7 ff2s s, T� c. T-N�',�y7�� z�js, 3sas
<br /> • " �ZCG '�� Z �S 5,�� . �. 1��'�wf�� , z���, 3.�aS
<br /> ���- . . . ' i � . � .
<br /> ��..�..._-. . . . . . . . .
<br /> �.� .... . ,. . . . . ...� . � � '
<br /> � .. . . . . .- . . . . . .
<br /> ;� _ . . � . . � � ,
<br /> ESTIMATED •'.,' ACTUAL . ./�/�- S. . . ., .. .
<br /> . . . .....:, . : -
<br /> � .,!�:-:i . . .
<br /> . Labor_(hours) Labor(hours) . . - '
<br /> , �
<br /> ; M.atena((cost) . Material.(cost)
<br /> - Equipment (cost) � Equipment (cost) ' -�
<br /> SCHEDUL�ING.,REQUESTED : : . '.'. ;� -
<br /> - "' tUSE�CHPi�GE�ACCOUNT NUMBER BELOW FOR LABOR:TIME'SLIPS.�ITEMIZE E , .a '"� t , \' � t';!, ":'
<br /> LABOR fEQUIPMENT fiND MATFRIALS ON REVERSE SIDE } ' i �
<br /> } . . : yx � .)�r �1 �� �.-.: � ., � ..-n f �� � �i" �
<br /> �'y ��.S�x F4�:�cn 4 J _ 4 ��:l��� � ' � t � ��� �� S }1),� .'h x����. .
<br /> Completio� (Dale) _ �_Cost $ � > '
<br /> ,�r :: i v� ' ��., , . -7. . � . .- :. , r` i, ``� � _
<br /> f � .,�..�, ... ' . . . ,-, .�,
<br /> + � �. . { � � �"
<br /> - , f4 Charge Account Number ' � ` Cha•ge Cost To(Name); - � r `
<br /> • � :!� +r � �� _ � � . � : � � . �l7 ..
<br /> ,` Address � - = Zip
<br /> . ..<: . o .__.. o . ._.i�`.
<br /> i 1a :�. r �. -� : _ � ` y . . _� J
<br /> ,'Z 'InGoice,No � � Amount $ ` ���' ' ` Date ' t
<br /> � y i
<br /> 1 '1 S i..} S' 'C..: . . . � ,. f 1� ,t l � �
<br /> ) � . ... - . . . ..... . . . . . . � . . y .• . :4` . .. . . .. .
<br />
|