Laserfiche WebLink
r <br /> OLTPUBLIC WORKS REQUEST • <br /> FOR WATER DEPARTMENT COST ESTIMATE <br /> (ATTACH 1 WATER PLAN FOR REFERENCE) Date Request Sent: 8/28/2017 <br /> Associated Permit#: PW1706-015 <br /> PROJECT ADDRESS: 3310 MCDOUGALL AVE <br /> DESCRIPTION OF WORK: ' SITE DEVELOPMENT FOR A 10,000SF WAREHOUSE AND SHOWROOM <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: Hill Street Investments NAME NEWLAND PETER <br /> ADDRESS: Po Box 5459 ADDRESS: <br /> Everett,WA,98206 , , <br /> PHONE: PHONE: 4257540700 <br /> EMAIL: EMAIL: PNEWLAND@WHIDBEY.NET <br /> CONTRACTOR: CONTACT: 0 Owner, 0 Applicant, ❑Other <br /> NAME: [ConName] NAME: [ContactName] <br /> ADDRESS: [ConAdd] PHONE: [ContactPhone] <br /> [ConCi], [ConSt], [ConZip] EMAIL: [ContactEmail] <br /> PHONE: [ConPhn] <br /> EMAIL: [ConEmail] <br /> REQUEST FROM PUBLIC WORKS REVIEWER: <br /> COST ESTIMATE REQUESTED BY: /J /�' 8r—CtO S 698/4 <br /> COST ESTIMATE REQUESTED FOR: <br /> CITY CREWS TO MAKE NEW CONNECTION TO MAIN <br /> • #OF CONNECTIONS NEEDED: 019 <br /> • TYPE OF CONNECTION: 7 ?-p ,QOr f-`rie <br /> • SIZE OF CONNECTION: 2 // <br /> • SIZE OF MAIN: c7//// <br /> 0 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: ❑ CONTRACTOR, ❑ CITY CREWS <br /> OTHER DESCRIPTION OR REQUEST: <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />