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EVERETT PUBLIC WORKS REQUEST <br />W A S H I N G T O N FOR WATER DEPARTMENT COST ESTIMATE <br />(ATTACH 1 WATER PLAN FOR REFERENCE) <br />Date Request Sent: 4/22/2022 <br />Associated Permit #: PW2109-057 <br />PROJECT ADDRESS: 2614 SUMMIT AVE <br />DESCRIPTION OF WORK: SITE WORK FOR ERC EVERGREEN MANOR <br />CONTACT INFORMATION: <br />OWNER: APPLICANT: <br />NAME: EVERGREEN MANOR NAME: <br />EVERGREEN RECOVERY CENTERS <br />ADDRESS: 2601 SUMMIT AVE ADDRESS: <br />11627 AIRPORT RD SUITE F <br />EVERETT, WA, 98201 <br />EVERETT, WA, 98204 <br />PHONE: PHONE: <br />4254935310 <br />EMAIL: EMAIL: <br />LGRANT@EVERGREENRC.ORG <br />CONTRACTOR: CONTACT: <br />❑ Owner, ❑ Applicant, ,00therCvsia-4c•ram <br />NAME: KIRTLEY COLE ASSOC LLC NAME: <br />DAWN BUSHNAQ <br />ADDRESS: 2820 OAKES AVE STE B PHONE: <br />2069636306 <br />EVERETT, WA, 98201 EMAIL: <br />DAWN@BUSHNAQSTUDIO.COM <br />PHONE: 4256090400 <br />EMAIL: JSCHWARTZ@KIRTLEY-COLE.COM <br />REQUEST FROM PUBLIC WORKS REVIEWER: <br />COST ESTIMATE REQUESTED BY: 44 �� �EwMhm <br />COST ESTIMATE REQUESTED FOR: <br />(� CITY CREWS TO MAKE NEW CONNECTION TO MAIN <br />• # OF CONNECTIONS NEEDED: 1• <br />• TYPE OF CONNECTION: — Ft QC — <br />SIZE OF CONNECTION: <br />4 I <br />• SIZE OF MAIN: E <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: <br />❑ CONTRACTOR, ❑ CITY CREWS <br />OTHER DESCRIPTION OR REQUEST: <br />n <br />2.7— <br />-- <br />Public Works Reviewer Signature <br />Date <br />REVISED 2/24/2016 <br />