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4 <br /> , r 4.77. PUBLIC WORKS REQUEST <br /> FOR WATER DEPARTMENT COST ESTIMATE <br /> (ATTACH 1 WATER PLAN FOR REFERENCE) Date Request Sent: 4/5/2017 <br /> Associated Permit#: PW1612-013 <br /> PROJECT ADDRESS: 1815 13TH ST <br /> DESCRIPTION OF WORK: PHASE II-SEATTLE CHILDRENS NORTH CLINIC <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: PROVIDENCE REGIONAL MEDICAL NAME: ZGF ARCHITECTS <br /> ADDRESS: 600 BROADWAY STE 304 ADDRESS: 925 4TH AVE STE 2400 <br /> SEATTLE,WA, 98122 SEATTLE, WA, 98104 <br /> PHONE: 2063202585 PHONE: 2065213505 <br /> EMAIL: EMAIL: FRANCES.VILLASENOR@ZGF.COM <br /> KIMBERLY.MCHUGH@PROVIDENCE.ORG <br /> N <br /> CONTRACTOR: CONTACT: 0 Owner, 0 Applicant, ❑Other <br /> NAME: ALDRICH &ASSOC INC NAME: EASTMAN SASCHA <br /> ADDRESS: 810 240TH ST SE PHONE: 2063430460 <br /> BOTHELL,WA, 98021 EMAIL: SASCHAE@CPLINC.COM <br /> PHONE: 4254831313 <br /> EMAIL: JBRINK@•LDRICH-ASSOC.COM <br /> REQUEST FROM PU: C WORKS REVIEWER: l PICIAk SadiSk. .' x laa" L <br /> COST ESTIMATE REQUESTED BY: aCbd k. ,11, <br /> COST ESTIMATE REQUESTED FOR: <br /> * CITY CREWS TO MAKE NEW CONNECTION TO MAIN \ <br /> • #OF CONNECTIONS NEEDED: C( ) _ <br /> • TYPE OF CONNECTION: ftYE— SVIA.R.Pc---' <br /> it <br /> • SIZE OF CONNECTION: � <br /> • SIZE OF MAIN: ell €xpikii, <br /> et U tt�II^tthv <br /> tl CITY CREWS TO INSTALL PIPE FROM MAIN TO BACK SIDE OF METER <br /> i <br /> • EXCAVATE, SHORE, AND RESTORE BY: g CONTRACTOR, ❑ CITY CREWS <br /> 1j l'r' TRAFFIC CONTROL BY: 0 CONTRACTOR, 0 CITY CREWS <br /> Or INSTALLATION AND PIPE THROUGH VAULT BY: 0 CONTRACTOR, 0 CITY CREWS <br /> OTHER DESCRIPTION OR REQUEST: V,VNIN-CA 1;2-C: - C.-'^(-C2 CO V p.� --Vo <br /> ----!/ L5il-23i <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />