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PUBLIC WORKS REQUEST ` t Le 06-fr <br /> FOR WATER DEPARTMENT COST ESTIMATE <br /> (ATTACH 1 WATER PLAN'FOR REFERENCE) Date Request Sent: 6/15/2016 <br /> Associated Permit#: PW1603-050 <br /> PROJECT ADDRESS: M4`, 905 80TH ST SW <br /> DESCRIPTION OF WORK: MTORRES MANUFACTURING BUILDING <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: MTORRES AMERICA NAME: MTORRES AMERICA <br /> ADDRESS: 21530 30TH DR SE,STE 210 ADDRESS: 21530 30TH DR SE,STE 210 <br /> BOTHELL,WA, 98021 BOTHELL,WA,98021 , <br /> PHONE: 4259842700 PHONE: 4259842700 <br /> EMAIL: mkinglsey@mtorresamerica.com EMAIL: mkinglsey@mtorresamerica. •mm <br /> CONTRACTOR: ONTACT: 0 Owner, 0 Applicant, 'OtherE/1gd111 /r <br /> NAME: [ConName] NAME: VERHEY JARED �U <br /> ADDRESS: [ConAdd] PHONE: 3607902312 <br /> [ConCi], [ConSt], [ConZip] EMAIL: JVERHEY@PACLAND.COM <br /> PHONE: [ConPhn] <br /> EMAIL: [ConEmail] jN'"sjj <br /> REQUEST FROM PUBLIC WORKS REVIEWER: <br /> COST ESTIMATE REQUESTED BY: 84(X Y ,(}�, ,( �vr <br /> COST ESTIMATE REQUESTED FOR: <br /> liet CITY CREWS TO MAKE NEW CONNECTION TO MAIN (Or) <br /> ■ #OF CONNECTIONS NEEDED: 2 on �`, - ( 804 St '(o/ (A).6S+) <br /> ■ TYPE OF CONNECTION: 34)c 19" Taftg 4 eernoe C; t. <br /> • SIZE OF CONNECTION: R� / <br /> ■ SIZE OF MAIN: i2" <br /> ❑ CITY CREWS TO INSTALL PIPE FROM MAIN TO BACK SIDE OF METER <br /> • EXCAVATE,SHORE,AND RESTORE BY: 0 CONTRACTOR, 0 CITY CREWS <br /> • TRAFFIC CONTROL BY: 0 CONTRACTOR, 0 CITY CREWS <br /> • INSTALLATION AND PIPE THROUGH VAULT BY: 0 CONTRACTOR, 0 CITY CREWS <br /> OTHER DESCRIPTION OR REQUEST: <br /> M WOT/Cdt011 of Ei)4Wihj /NJ dinGilift id- 8614 8C1— S>tiO <br /> xi°Jiiila / //; s ao'� <br /> O I r <br /> Public Works Reviewer Signature Dat <br /> REVISED 2/24/2096 , <br />