ENG20160484-WATER METER.pdfCITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
hoc,, PHONE: (425) 771-0220 FAX: (425) 771-0221
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16531 13TH AVE W STE A] 07
16531 13TH AVE W STE A107
LYNNWOOD, WA 98037 LYNNWOOD, WA 98037
(425)742-6044
LICENSE #: SELECHII I OKN __ EXP: 12/31/2016
JOB
DESCRIPTION OF WORK:
INSTALL
DETER SIZE: 1"
Y NEW SERVICE FROM CITY MAIN TO PROPERTY LINE
Y ASPHALT/CONCRETECUT
Y FINAL PATCH BY CONTRACTOR
INSTALLATION FEE: $2,970.00
CONNECTION FEE: $5,050.00
STREET CUT DEPOSIT: $0.00
OWNERNAME: SELECT HOMES
BILLING ADDRESS: 1653113TH AVE W STE A 107 LYNNW OOD, WA 98037
Y SFRMOTHIR-
IRRIGATION N APARTMENT / CONDO - UNITS: 0
N 'DUPLEX 'FIRE CONNECTION NN MIXED USE -COMMERCIAL FLOORS: 0
N TRIPLEX RESIDENTIAL UNITS: 0
N COM OFIREIDOMESTICBACKFLOW ASSEMBLY REQUIRED
METER NUMBER:
STYLE:
LOCATE REQUEST #:
DATE CALLED:
METER READING AND
MANUFACTURER'S it, REGISTER #:
METER LOCATION:
SERVICE MATERIAL: PRESSURE: 0 GPM: 0
DATE OF WORK: WORK BY:"
REMARKS:
* * *ATTACH DRAWING WHEN NECESSARY*
U/B ACCOUNT: ROUTE:
READ AFTER ADDRESS: WATER SUPPLIER:
;SUED ENG20160484
TYPE OF REPAIR AREA REPARUD REPAIR COST
Asphalt Roadway/Walkway ( Ft X Ft) = Sq. Yds
( Ft X Ft) = Sq. Yds
( Ft X Ft) = Sq. Yds
Concrete Sidewalk ( Ft X Ft)-;' Sq. Yds
( Ft X Ft) -; Sq. Yds
( Ft X Ft) = Sq. Yds
0 Concrete Curb Lineal Ft
Lineal Ft
Lineal Ft
Total Repair Costs:
Less Street Cut Deposit: $0.00
Invoice/Refund: