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PUBLIC WORKS REQUEST <br /> FOR WATER DEPARTMENT COST ESTIMATE <br /> (ATTACH 1 WATER PLAN FOR REFERENCE) Date Request Sent: 6/30/2016 <br /> Associated Permit#: PW1606-037 <br /> PROJECT ADDRESS: 1208 100TH ST SW <br /> DESCRIPTION OF WORK: NEW SFR WITH 4 CAR ATTACHED GARAGE '� <br /> � �� � ��� ��3'` <br /> CONTACT INFORMATION: '` `" � <br /> OWNER: APPLICANT: <br /> NAME: HAACK BROS CONST INC NAME: HAACK JOEL <br /> ADDRESS: 3922 87TH AVE NE ADDRESS: <br /> MARYSVILLE,WA, 98270 <br /> PHONE: 4253977360 PHONE: 4252902429 <br /> EMAIL: EMAIL: <br /> CONTRACTOR: CONTACT: ❑ Owner, ❑ Applicant, ❑Other <br /> NAME: HAACK BROS CONST INC NAME; [ContactName] <br /> ADDRESS: 3922 87TH AVE NE PHONE: [ContactPhone] <br /> MARYSVILLE,WA, 98270 EMAIL: [ContactEmail] <br /> PHONE: 4253977360 <br /> EMAIL: <br /> REQU�ST FROIV7 PUBLIC VVOR{{S REVIEWER: <br /> COST ESTIMATE REQUESTED BY: �%/"� �%C%G�-�' <br /> COST ESTIMATE REQUESTED FOR: (����n ��� <br /> ��� `J� <br /> �Q r.51 a..�C ' <br /> ❑ CITY CREWS TO MAKE NEW CONNECTION TO MAIN <br /> ■ #OF CONNECTIONS NEEDED: <br /> ■ TYPE OF CONNECTION: <br /> • SIZE OF CONNECTION: <br /> • SIZE OF MAIN: <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: <br /> � • // " / �/ <br /> .,�i?,SS � �� vl�'GLt �7 C�i"�Z`!� C'ivJ �X/�7�/y! 1 Z I�'/C(/�J <br /> �G �' � (' G <br /> �� (�-�U l� <br /> Public Works Reviewer Signature � Date <br /> REVISED 2/24/2016 � <br />