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/,70 {'EE' Foe _DE ✓ELoPOmzP 7T CITY OF RENTON
�.aaNGiNEERt!4G DEPARTMENT
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10. The required "PRESSURE TEST" has been taken by
At a pressure of PSI , for _ minutes, on
The test: Foiled Passed Comments
11. The required "PURITY TEST" has been taken by
On Date of Reply Failed __ r
Passed Comments
12. Is there an Easement required? If so, give dates for:
Preliminary Submitted
And Reca."ded Number
13. This Project included LF of CJ C 1J:atermain
„
n
And _1—�j Gate Valves Gate Valves
Gate Valves and Gate Valves,
_ Ca,
And all miscellaneous accessories for a total valve of
Also, Size Make type Fire Hydrants for a
total value of $
14, The transfer or "Bill of Sale" is in; Preliminary
Submitted .Zecorded `orm.The recorded number
15. This project information was sent to the I;tility Dept. for recording on
and taken into "plant" on
16. What drawings does the Water S`rop have on File.
Fes-
Preliminary As-Built
4
Form Completed on
City of Renton
Utility Department P-oject Form
I , Water Project M }J Date Project No. given
2. Project Description and location ( ) . D. r1 L—,k; Rtt,aa
130 (-T-v AJ -Iti �''
3. Developer's Name _ (If City check �� )
Address
_ r
Phone N
Engineer's Name _(If City check )
Address
Phone N _
Contractor's Name v_ _(If City check
Address
Phone M
4, Is there an ACTIVE Late-Come rs Agreement in the project area? _ A( V
If sc, give File Name
Recording Date And Number
r
5, The Utility Department Work Order Numbers on this project are as follows: i
6. What plans have been suamitted? Preliminary _i—J'a-Built
7, Has an Estimate been Prepared for Project I---- If so, give Date Prepared
_And Total Amount of Estimate
8. Is there to be a Late-Comers Agreement on th;s project _ r1I LJ If so, give
dates for; Preliminary Submitted _ Recorded
and Recorded .iumb
9. Date of "Start of Construction'' _ Date of "Completion"
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