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9 <br />EVERETT PUBLIC WORKS REQUEST <br />WAS H I N GTO N FOR WATER DEPARTMENT COST ESTIMATE <br />(ATTACH 1 WATER PLAN FOR REFERENCE) Date Request Sent: 4/7/2022 <br />Associated Permit #: PW2111-007 <br />PROJECT ADDRESS: 4937 EVERGREEN WAY <br />DESCRIPTION OF WORK: SITEWORK FOR NEW QFC FUELING STATION <br />CONTACT INFORMATION: <br />OWNER: <br />NAME: <br />CLAREMONT VILLAGE STATION LLC <br />ADDRESS: <br />11501 NORTHLAKE DR <br />CINCINNATI, OH, 45249 <br />PHONE: <br />2068080303 <br />EMAIL: <br />BRIAN.PETERSON@KROGER.COM <br />CONTRACTOR: <br />NAME: <br />NEED CONTRACTOR INFORMATION <br />ADDRESS: <br />PHONE: <br />REQUEST FROM PUBLIC WORKS REVIEWER: <br />COST ESTIMATE REQUESTED BY: Abiy Tsegaye <br />COST ESTIMATE REQUESTED FOR: <br />APPLICANT: <br />NAME: <br />JOEL HOWITT <br />ADDRESS: <br />PHONE: <br />is <br />4252516222 <br />EMAIL: <br />JHOWITT@BARGHAUSEN.COM <br />EMAIL: <br />CONTACT: ❑ <br />Owner, ❑ Applicant,�00ther— <br />NAME: <br />JOEL HOWITT <br />PHONE: <br />4252516222 <br />EMAIL: <br />JHOWITT@BARGHAUSEN.COM <br />ok CITY CREWS TO MAKE NEW CONNECTION TO MAIN <br />■ # OF CONNECTIONS NEEDED: 1 <br />■ TYPE OF CONNECTION: —New Hydrant for the QFC Fueling <br />Station <br />■ SIZE OF CONNECTION: 6" <br />■ SIZE OF MAIN: 6" Cl <br />❑ CITY CREWS TO INSTALL PIPE FROM MAIN TO BACK SIDE OF METER <br />• EXCAVATE, SHORE, AND RESTORE BY: ❑ CONTRACTOR, ❑ CITY CREWS <br />• TRAFFIC CONTROL BY: ❑ CONTRACTOR, ❑ CITY CREWS <br />• INSTALLATION AND PIPE THROUGH VAULT BY: ❑ CONTRACTOR, ❑ CITY CREWS <br />OTHER DESCRIPTION OR REQUEST: <br />Public Works Rckiewer Signaidre Date <br />REVISED 2/24/2016 <br />