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CITY OF EVERETT <br />DEPARTMENT OF PUBLIC WORKS <br />UTILITY WORK ORDER <br />Date: �zt! .i'2• F WATER <br />❑ SEWER <br />❑ STORM <br />Location: <br />WX ry <br />r- <br />UTILITIES DIVISION <br />W.O. No. <br />4'/�,,,)Acct. No. <br />7380 <br />i_ 1) / <br />Complaint No. _ <br />SERVICE ❑ MAINTENANCE <br />❑ MAIN ❑ OPERATION <br />❑ PUMP STATION �V REPAIR <br />❑ TREATMENT ❑ CONSTRUCTION <br />❑ <br />RESERVOIR <br />❑ <br />VALVE <br />❑ <br />MAN HOLE <br />❑ <br />CATCH BASIN <br />❑ <br />DITCH <br />W.O. Instructions: /2 i J;po I R S C41 ai- _ <br />Ar.TUA1 <br />LV 111•In lv <br />Labor (hours) Labor (hours) <br />Material (cost) _ Material (cost) <br />Equipment (cost) : _ Equipment (cost) — <br />SCHEDULING REQUESTED <br />USE CHARGE ACCOUNT NUMBER BELOW FOR LABOR TIME SLIPS- ITEMIZE, <br />LABOR, EQUIPMENT, AND MATERIALS ON REVERSE SIDE. <br />Completion (Date): I Cost:$ _ <br />Charge Acc unt Number: <br />Address: <br />Charge Cost To (Name): — <br />U <br />Invoice No.: ___ — _Amount:$ _—Date: <br />tias <br />