615 80TH ST SW 2022-01-03 - Laserfiche WebLink

PUBLIC WORKS REQUEST FOR WATER DEPARTMENT COST ESTIMATE (ATTACH 1 WATER PLAN FOR REFERENCEDate Request Sent: 3/14/2017 PROJECT ADDRESS: 615 80TH ST SW ) t DESCRIPTION OF WORK: SITE WORK FOR BLDG ADDITION CAssociated Permit #: PW1612-044 -- fpj p Associated A616 CONTACT INFORMATION: OWNER: APPLICANT: NAME: TYTUS WILLIAM B & SUSAN B NAME: [AppName] ADDRESS: 615 80TH ST SW ADDRESS: [AppAdd] EVERETT, WA, [AppCi], [AppSt], [AppZip] PHONE: PHONE: [AppPhone] EMAIL: EMAIL: [AppEmail] CONTRACTOR: CONTACT: ❑ Owner, ❑ Applicant, ❑Other NAME: SUPERSTRUCTURES INC NAME: NELSON NED ADDRESS: 2221 EVERETT AVE PHONE: 4254446782 EVERETT, WA, 98201 EMAIL: nednelson@msn.com PHONE: 2067860198 EMAIL: jimarmstrong@superstructuresinc.com . lm !L( REQUEST FROM PUBLIC WORKS REVIEWER: �„ COST ESTIMATE REQUESTED BY: t Sa h nknQ I(�/11 Ae'r COST ESTIMATE REQUESTED FOR: CITY CREWS TO MAKE NEW CONNECTION TO MAIN ■ # OF CONNECTIONS NEEDED: 1 ■ TYPE OF CONNECTION: rr 071 �� rr � ` - E Q- ■ SIZE OF CONNECTION: ■ SIZE OF MAIN: ❑ CITY CREWS TO INSTALL PIPE FROM MAIN TO BACK SIDE OF METER • EXCAVATE, SHORE, AND RESTORE BY: ❑ CONTRACTOR, ❑ CITY CREWS • TRAFFIC CONTROL BY: ❑ CONTRACTOR, ❑ CITY CREWS • INSTALLATION AND PIPE THROUGH VAULT BY: ❑ CONTRACTOR, ❑ CITY CREWS OTHER DESCRIPTION OR REQUEST: Cr Public Works Reviewer Signature Date -