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EVERETT PUBLIC WORKS <br />REQUEST <br />WASHINGTON FOR WATER DEPARTMENT <br />COST ESTIMATE <br />(ATTACH 1 WATER PLAN FOR REFERENCE) <br />Date Request Sent: W3012022 <br />Associated Permit#: U2206-032 <br />PROJECT ADDRESS: 516 47TH ST SE <br />DESCRIPTION OF WORK: MOVE EXTG WATER SERVICE FROM BLACK FOREST TO 47TH ST SE -LEAK <br />CONTACT INFORMATION: <br />OWNER: APPLICANT: <br />NAME: THAYER JEFF B WELLIN NAME: <br />[AppName] <br />ADDRESS: 808 E LAKESHORE DR ADDRESS: <br />[AppAdd] <br />LAKE STEVENS, WA, 98258 <br />[APpCI], [APpSQ, [APPT-iP] <br />PHONE: 4255309267 PHONE: <br />[AppPhone] <br />EMAIL: ASHLEYTHAYER24@GMAIL.COM EMAIL: <br />[AppEmail] <br />CONTRACTOR: CONTACT: ❑ Owner, ❑ Applloant, [30mor <br />NAME: [ConName] NAME: <br />THAYER JEFF S WELLIN <br />ADDRESS: [ConAdd] PHONE: <br />4255309267 <br />[ConCI],[ConSt],[CenZip] EMAIL: <br />ASHLEYTHAYER24@GMAIL.COM <br />PHONE: [ConPhn] <br />EMAIL: [CenEmail] <br />REQUEST FROM PUBLIC WORKS REVIEWER®: <br />COST ESTIMATE REQUESTED BY: TYYW I'4VI A t n ,/1 <br />COST ESTIMATE REQUESTED FOR: <br />CITY CREWS TO MAKE NEW CONNECTION TO MAIN <br />• #OF CONNECTIONS NEEDED: <br />1I <br />WtiM Sayicri <br />• TYPE OF CONNECTION: <br />3�{p <br />• SIZE OF CONNECTION: <br />• SIZEOFMAIN: / 11 <br />❑ CITY CREWS TO INSTALL PIPE FROM MAIN TO BACKSIDE 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: <br />❑CONTRACTOR, ❑CITY CREWS <br />OTHER DESCRIPTION OR REQUEST: <br />S Vi <br />'R acV <br />l/xj v, �8y <br />usse�. <br />ob&46oLVRL JwVgna"Ium <br />Date <br />