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C08T LBTIKl1TE BHEET <br />Receipt N <br />t}ost of Work Order $ <br />PUBLIC WORKS DEPARTMENT <br />UTILITIES DIVISION <br />2300 CEDAR STREET <br />EVERETT, WASHINGTON 98201 <br />(206) 259-8800 <br />Date Paid <br />Work Order � <br />_� Cost of Service Order $ S 5-3 9 Service Order # <br />Trin,Ksf-P�K . <br />Requested By: -}�-.L�a—.</-1�K---f-� f-t—i7t,�,�r,r.��Date of Request ��" � y' b'� <br />Property owner (name) � o wc // Go t�i w� u ti� y y i b•ti r� l <br />Charqe Coat to (name if different than owner) ' s�(r+-e <br />l�ddress �D � O S� 4%� Srcn��✓City ���n't;� Zip �/ �� o/ <br />Installation Location ����-� <br />Installation type/description/size/etc. �,Y"Lr/a ��l %C. � 1�/o y?'A,/�, <br />f rY� 5�1'ti c f r/ A.�r�'Ul � .Y,7 It cr I' c��`��-Z u �-[�� <br />The following estimate is based upon the Utilities Divis�.on providing <br />all labor, equipment, materials, restoration, and final hook-up. A <br />double check valve assembly for temporary service is available from the <br />City�s Permit Counter by requesting a Hydrant Use Permit with an <br />additional deposit. <br />Whenever the estimated cost is not sufficient to cover the total expense <br />for labor, material, equipment rental and administrative costs, the <br />deficit shall be charged to the property for which such installation was <br />made and the owner thereof, and provided further, that any excess <br />payment sha11 be returned to the person applying for the installation. <br />Itemised Cost Eatimate: <br />Labor 6 overhead <br />Material <br />z6,�� <br />l/ 03 <br />Equipment Rental iP `/� <br />Surface Restoration /°`v <br />service order Cost s 5 3 y <br />Total <br />Prepared by f�. ��ti��� <br />cc: Tim Tyler <br />Don Weitkamp <br />Larry Crawford <br />Tom Thetford <br />Clair olivers <br />Revised 3/15/88 <br />