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0 <br /> PUBLIC WORKS REQUEST <br /> ,,--''' 4E, FOR WATER DEPARTMENT COST ESTIMATE <br /> (ATTACH 1 WATER PLAN FOR REFERENCE) Date Request Sent: 6/14/2018 <br /> Associated Permit#: PW1711-029 <br /> PROJECT ADDRESS: 10611 EVERGREEN WAY <br /> DESCRIPTION OF WORK: SITE WORK FOR ADDITIONS TO SHOWROOM &SERVICE BAY <br /> CONTACT INFORMATION: I'! <br /> OWNER: APPLICANT: <br /> NAME: S R KLEIN FISH-ON INVESTMENTS LLC NAME: [AppName] CO <br /> ADDRESS: PO BOX 3830 ADDRESS: [AppAdd] <br /> i <br /> EVERETT,WA,98213 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] - <br /> CONTRACTOR: CONTACT: ❑ Owner, 0 Applicant, DOther <br /> NAME: GAFFNEY CONSTRUCTION NAME: [ContactName] <br /> ADDRESS: 8105 BROADWAY PHONE: [ContactPhone] <br /> EVERETT,WA, 98203 EMAIL: [ContactEmail] <br /> PHONE: 4253555500 <br /> EMAIL: JOE@GAFFNEYCONSTRUCTION.COM <br /> REQUEST FROM PUBLIC WORKS REVIEWER: <br /> COST ESTIMATE REQUESTED BY: 3 0,h rfri(L, I <br /> , <br /> COST ESTIMATE REQUESTED FOR: <br /> ❑ CITY CREWS TO MAKE NEW CONNECTION TO MAIN <br /> ■ #OF CONNECTIONS NEEDED: <br /> • TYPE OF CONNECTION: 0 r <br /> ■ SIZE OF CONNECTION: 3 <br /> • SIZE OF MAIN: g <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, 0 CITY CREWS <br /> • INSTALLATION AND PIPE THROUGH VAULT BY: 0 CONTRACTOR, 0 CITY CREWS <br /> OTHER DESCRIPT ON OR REQUEST: , C9G 4- f") < 6 <br /> (WO0811Ev QM N n`f° <br /> 47,14 fro ad , i tirtaer/ 4 I a 1/1 g 4 l E ? <br /> ArldnAthjlei 1 -64r &)(gtter..a (gas+ Qt-rnFAilb-ri is 1154 bak11) <br /> Ai 7 <br /> J <br /> /6"7/#11), 6 f /i/e/26/X <br /> Pub6C Works Reviewer Signature 1 Dat <br /> REVISED 2/24/2016 <br />