25-122.00ConsolidatedIrrigationDistrictFloraParkCrossCountryCIP#0361Consolidated Irrigation District No. 19 Account No.
120 N Greenacres Road
Greenacres, WA 99016
(509)924-3655/fax (509) 924-3927
Email: consolidatedirrigation@comcast.net
REQUEST FOR NEW SERVICE
#25-122
CUSTOMER/CONTRACTOR: City of Spokane Valley
MAILING ADDRESS: 10210 E. Sprague Ave, Spokane Valley, WA 99206 Dwelling
TELEPHONE: Fax: Commercial
PROPERTY ADDRESS: 2520 N Flora RD Duplex
Email: Pressure Area
55072.0324
COUNTY PARCEL No.: 55072.0319 Plat: CoSV Cross Country Building: Block:
55072.0318
DESCRIPTION OF WORK REQUESTED:
6" Meter Install - District to provide 6" Master Meter and 2" Master Meter with bypass within vault.
Owner to extend 8" watermain on Flora road to south of Rail Road tracks. See plans for watermain extension.
District to oversee installation of extension of main including witnessing testing and sampling. Including in fees below.
ESTIMATED CHARGES
6" Metered Service w/ cap fees $35,000.00
2" metered service including bypass w/ cap fees $9,700.00
6" (45,000), 2" (7,800), 1 Fire Hydrant (1,200) Annexation Fees $54,000.00
TOTAL ESTIMATED DEPOSIT $98,700.00
I request water service from Consolidated Irrigation District No. 19 and I understand that the above stated estimated costs reflect
the Estimated Labor, Equipment, Material, Overhead, Taxes, and Capitalization Fee Charges for the proposed contract work. I
also understand that if the final costs exceed the estimate, the balance will be due within thirty (30) days and that if they are less I
will receive a refund within thirty (30) days. I further agree to abide by the Rules and Regulations as established by the Board of
Directors of Consolidated Irrigation District No. 19.
I also agree that as a condition of receiving water service, proper access to the water service will be provided and that no
obstruction will be constructed to interfere with the inspection of or maintenance to the water service. If so determined by the
District, an obstruction to the water service will be required to be removed or modified as a condition to continued water service
Date: John Hohman, City Manager
Printed Name
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Sig ture
RECEIVED DEPOSIT
DATE AMOUNT RECEIPT No.