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AOL <br />IF MW <br />E V E R E T T PUBLIC WORKS REQUEST <br />WASHINGTON FOR WATER DEPARTMENT COST ESTIMATE <br />(ATTACH 1 WATER PLAN FOR REFERENCE) <br />Date Request Sent: 2/5/2020 <br />Associated Permit #: PW7907-020 <br />PROJECT ADDRESS: 3301 LOMBARD AVE <br />DESCRIPTION OF WORK: SITE WORK FOR COMPASS HEALTH <br />CONTACT INFORMATION: <br />OWNER: <br />APPLICANT: <br />NAME: COMPASS HEALTH <br />NAME: ENVIRONMENTAL WORKS <br />ADDRESS: 4526 Federal Avenue MS#30 <br />ADDRESS: 402 15th Ave East <br />EVERETT, WA, 98203 <br />SEATTLE, WA, 98122 <br />PHONE: 4253498413 <br />PHONE: 2067871369 <br />EMAIL: tom.sebastian@compassh.org <br />EMAIL: ccongdon@eworks.org <br />CONTRACTOR: <br />CONTACT: ❑ Owner, ❑ Applicant, ❑Other <br />NAME: BNBUILDERS INC <br />NAME: CHRISTINA CONGDON <br />ADDRESS: 2601 4TH AVE STE 350 <br />PHONE: 2067871369 <br />SEATTLE, WA, 98121 <br />EMAIL: ccongdon@eworks.org <br />PHONE: 2063823443 <br />EMAIL: <br />REQUEST FROM PUBLIC WORKS REVIEWER: <br />COST ESTIMATE REQUESTED BY: <br />COST ESTIMATE REQUESTED FOR: <br />CITY CREWS TO MAKE NEW CONNECTION TO MAIN <br />■ # OF CONNECTIONS NEEDED: <br />■ TYPE OF CONNECTION:U' Do m <br />y zi ft ssyy�-e <br />■ SIZE OF CONNECTION®#+,ix1!'I, s"ou, <br />0y, l2 "�asian r7'tA 6 an l2'°A <br />■ SIZE OF MAIN: / 2'° <br />ZnAln <br />❑ CITY CREWS TO INSTALL PIPE FROM MAIN TO BACK SIDE OF METER <br />• EXCAVATE, SHORE, AND RESTORE BY: <br />❑ CONTRACTOR, ❑ CITY CREWS <br />• TRAFFIC CONTROL BY: <br />❑ CONTRACTOR, ❑ CITY CREWS <br />• INSTALLATION AND PIPE THROUGH VAULT BY: ❑ CONTRACTOR, ❑ CITY CREWS <br />OTHER DESCRIPTION OR REQUEST: <br />Sf/& U and ab® VIE, 4K AM <br />n rS' .� �► � ��o <br />Public Works Reviewer Signature <br />Date <br />