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City of Everett Work Activity <br /> Work Osler Information <br /> Service Regr est M WON Assigned I I g 9 9 d % 1 <br /> Date Issued I <br /> Issued By <br /> initial, Ful!name <br /> Fund O ( Program p Functie. Activity <br /> Job Cost No F / Project No. <br /> Title '—tel tllf SZ%z--- '- <br /> Re!►York Order 9 © •J 1 7 <br /> Problem Information <br /> Address Pmdirection Street Street Type Postdirection <br /> l ❑ 1 :1 E�zl 0 <br /> City F— —� <br /> •Ifnot "Everett 'spech,whichCity• <br /> Structure/Equipment Information <br /> Struct/EquipType ��!?_ Problem <br /> Struct/Equip No �1 S D �s/�D 19 Sub Problem <br /> StructuretEqur'pment type when applicable <br /> Feet C—� Description <br /> Comments <br /> Bold Type-Mandatory fields to be populated <br /> Italic - Optional fields <br /> FORMS.WRKACTVY)(CM 01/2699) <br />