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_ POBLIC WORKS DEPARTMENT <br /> U7'ILITIES DIVISION <br /> CO6T E6TIHi1TE 6HEET 2300 CEDAR STREET <br /> EVERETT, WASHINGTON 98201 <br /> (206) 259-8800 <br /> Receipt f �a��� Date Paid /�'.�"i�. <br /> X Cost of Work Order S 5694.00 Work Order � <br /> Cost of Service Order 5 Servi.ce Order a <br /> Conta�=t Person: KIRK BRO�ItS Telephone f 774-1686 <br /> Requested By: DAVE SATERSTROM Date of Request <br /> Property Owner (name) <br /> Charge Cost to (name if diEferent than owner) <br /> Address 1515 FULTON City EVERETT 2ip 98201 <br /> Installztion Location 16TH STREET AND FULTON <br /> Installation type/description/size/etc. EXCAVATE 12" STEEL TAP. 2" <br /> AND INSTALL 2�J� OF 2" PLASTIC AND RESTORE P.REA <br /> [X] The following estir�ate is based upon the Utilities Division <br /> providing all labor, equipment, materials, restoration, and final <br /> hook-up. <br /> [ ] The following estimate is based upon the Street Division work group <br /> providing all labor, equipment, materials and restoration to <br /> property. <br /> Whenever the estimated cost is not su:ficient to cover the total expense :or labor, <br /> ma[erial, equipment rental- and administrative costs, the defic:t ahall be charged to <br /> the psoperty for vhich such installation was made and t�e ovner thereof, anC provided <br /> further, that any excess payment shall 6e re[urned to the person applying far the <br /> installation. <br /> ItCID12¢d C09t E9t1IDdtC: <br /> Labor 6 Overhead S �072.0o ec: Bldg. Pe:mit couneer <br /> Clair olivers <br /> Mdteildl 960.00 Tam Thetiord <br /> Don Neitkamp <br /> Equipment Rental �1a62.00 xirk arooks � <br /> Cordon Nitcher <br /> Surface Restoration 200.00 0. non Nahl <br /> Dan Louell <br /> Total 5694.00 -2= Sean ifi�chell . <br /> i / 1BS�7a� E"'pnc'�.,+: s�,areofn�,�n�1e„s�o, <br /> Prepared by ^��- ' + 650°O fnr 3i{j9SCrvic.0 <br /> N 3`�1 97°o <br /> Accepted � y Representing <br /> + q3S•33F.N. Sh4r°L'.'..e ae/�a/+t <br /> o�� �, � — D �l�irrST�_ <br />