Laserfiche WebLink
E V E R E T T PUBLIC WORKS REQUEST <br /> WASHINGTON FOR WATER DEPARTMENT COST ESTIMATE <br /> (ATTACH 1 WATER PLAN FOR REFERENCE) Date Request Sent: 3/4/2022 <br /> Associated Permit#: U2203-006 <br /> PROJECT ADDRESS: 1920 BROADWAY <br /> DESCRIPTION OF WORK: NEW WATER SERVICE INSTALLATION 1" DOM METER ONLY <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: BOOTA SINGH NAME: [AppName] <br /> ADDRESS: 17303 34TH PL W ADDRESS: [AppAdd] <br /> LYNNWOOD,WA, 98037-7732 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: BOOTA21@LIVE.COM EMAIL: [AppEmail] <br /> CONTRACTOR: CONTACT: ❑ Owner, ❑ Applicant, Mother <br /> NAME: [ConName] NAME: ROD WICKHAM <br /> ADDRESS: [ConAdd] PHONE: 4252522789 <br /> [ConCi], [ConSt], [ConZip] EMAIL: RAD.DESIGN@HOTMAIL.COM <br /> PHONE: [ConPhn] <br /> EMAIL: [ConEmail] <br /> REQUEST FROM PUBLIC WORKS REVIEWER: <br /> COST ESTIMATE REQUESTED BY: Thad Newport <br /> COST ESTIMATE REQUESTED FOR: <br /> ® CITY CREWS TO MAKE NEW CONNECTION TO MAIN <br /> ■ #OF CONNECTIONS NEEDED: 1 <br /> ■ TYPE OF CONNECTION: 1" DOMESTIC/FIRE COMBINATION METER <br /> ■ SIZE OF CONNECTION: <br /> 1" <br /> ■ SIZE OF MAIN: 4" D.I. <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: UPSIZE EXISTING 3/4" METER TO 1" METER FOR FIRE SPRINKLERS <br /> 03/04/2022 <br /> Public Works Reviewer Signature Date <br /> REVISED 212412016 <br />