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~c / ~~ ~ <br />MI~2ION COUNTY TELEPHOtdE ADD, MOVE AND CIiA_NGE ORDER <br />DEPARTMENT ~~C /`1/'U~i?!! ~' CONTACT PERSON ,~jfj ~ <br />IACATION CONTACT PHONE NR <br />Bui.lding, Floor, 32oom, etc <br />E3UDGET ` 7 ~,> - ~ ~ - ~ Li~ PROJECT ~ ~~1 ~PE OF PHONE <br />' SLl,Tap,Button <br />Description of add, move or chanqe request: <br />< P~ <br />_ -'V1C~ ~., P ~SrY~.b l~ ~ ~'1 ~N~ "~'f~ ~.`,f? ~`-~ ~x ~ i f' ~~ <br />~ <br />1 ~~ C_ ~rt -r-rtr~' <br />AUTHORIZED SIGNATURE DATE <br />wOR~ PERFOR.MED: <br />TECf~NICIAN'S TIME <br />Date Start Stop HRS MATERIALS Qty Cost <br />i o ~- 3 3 ; ~'~' ~ ' ~ ° E ~. ~ ' ~ ~ ~~ ~ti~ ,-~~ti', '~~ <_ , .~~ ~ ~3 <br />Q:,^r P`? G r ~'; ,i , j i <br />~~ 2 ~ • ~ _. ' y'`1C'~ t~~cG+_ ~ ~- ~ , ~e <br />S U E3`I'O'I'A L _ `` ~v - ~ J ( . <br />__.~~._______ S U E3TOTA L I <br />-~-- / -- ~ ~ 3 <br />~~ ~ ~ 7 3 <br />DATE BI LLED ______ _____ TOTAL Cf~ARGED -__ <br />-~ Work completed Yes Na <br />~.~^~ - ~I ~-,.-,,.,~ ~ --~--~__ Extens ion NRs ed : <br />T~chnician's Signature <br />Department verificaLion of wor.~k performed <br />Department Signature Date <br />POF2M MC 11-PP26 REV 10/II8 <br />Whi te - Invoice Yel l_ow - vendor <br />Pink - Department <br />