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City of Everett Work Activity <br /> Work Order Information <br /> Service Request k WOM Assigned I lqqcl 03'7/ <br /> Date Issued / <br /> Issued By G' /q -�� Xy xzzr✓ <br /> initials Full name <br /> Fund EZ, / F51 Program 7/p Function // Activity �7S <br /> Job Cwt No - Project No. <br /> Title <br /> Ref Wort.Order <br /> Problem Information <br /> Address Predirection Street Street Type Postdirection <br /> 3/3 El I �� ST <br /> cio <br /> •if not "Everett"specify which City* <br /> Structure/Equipment Information <br /> Struct/Equip Type Problem <br /> Struct/Equip No 1//,s aers Mph Sub Problem <br /> StruclurelEqulpmenl type when applicable <br /> Feel E= ] Description <br /> Comments rJP/fA/Jleg JeIC!//eG ro ,ve Iv r" ,(�A/�✓ <br /> Bold Type-Mandatory fields to be populated <br /> halic - Option!fields <br /> FORMS:WRKACrVYJ ICM 01/26/99) <br />