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� CITY 01= EVERETT <br />" �' ' DEPARTMENT OF PUBLIC WORKS <br />UTIL.ITIES DIVISION <br />♦;. � <;-`� <br />�s/ ��o �����1)C- <br />,r� <br />UTILITY WORK QRDER <br />Date: � ag�g! �WATER <br />❑ SEWER <br />❑ STORM <br />Location: �� <br />W.O. Instructions: <br />ESTIMATED <br />Labor (hours) <br />Material (cost) <br />Equipment (cost) <br />�Jh ���- <br />� <br />.i E' .S �/�J � <br />��� d. <br />❑ SERVICE <br />O MAIN <br />❑ PUMP STATION <br />❑ TREATMENT <br />❑ RESERVOIR <br />❑ VALVE <br />❑ MAN HOLE <br />❑ CATCH BASIN <br />❑ DI'fCH <br />ACTUAL <br />I . . _ �' <br />`��- � ��> <br />W.�. No. C�»—�i s- <br />Acct. No. <br />Complaint No. <br />C�}' i�1AINTENANCE <br />❑ OFERATION <br />❑ REPAIR <br />❑ CONSTRUCTION <br />Labor (hourc) <br />Material (cost) <br />Equipment (cost) <br />SCHEDULING REQUESTED <br />USE CHARGE ACCOUNT NUMBER BELOW FOR LABOR TIME SLIPS. ITEMIZE <br />LABOR, EQUIPMENT, AND �•1ATERIALS ON REVERSE SIDE. , <br />Completion (Date): ��? �� �% Cost:� <br />Charge Account Number: <br />Address: 3a� HiVdOUC, <br />ea l e � [�� <br />Invoice No.: <br />iias <br />Charge Cost To (Name):%R�R D DPueluDfY�Ph � 1��/C. <br />E. �?35 P6. /jnv RSD7n �:... 9RIdR -�47L <br />Date: <br />p <br />