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City of Everett Work Activity <br /> Work Order Information <br /> Service Request M WON Assigned <br /> Date honed -3- 17-92 <br /> lashed By eo J _ <br /> 111!114!1 Full name <br /> Fund p } F-5-1 Program (p Function j j Activity 67 <br /> Job Cost No Project No. <br /> t <br /> Title <br /> Rel Work Order <br /> Problem Information <br /> Address Predirection Street Street Type Postdirection <br /> =3 ❑ 1 sG <br /> city I <br /> --� <br /> *If not "Everett"spect&which Ciry <br /> Structure/Equipment Information <br /> Struct/EquipType Problem <br /> Struct/F,quip No S 6 d�y o Sub Problem <br /> Structure/Equipment ryhe when applicable <br /> Feet Description <br /> Comments r7 O J S�T�— <br /> Bold Type a Mandatary fields to be populated <br /> Italic n Optional fields <br /> FORMS.WRKACTVYJ(CM 01/16/99) <br />