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PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 4522 EVERGREEN WAY Permit#: B1808-017 <br /> TENANT: STATE FARM <br /> DESCRIPTION OF WORK: NON-STRUCTURAL EXT RENO&INTERIOR PARTITIONS-STATE FARM <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Not Including Cost Estimates) <br /> ❑ New Connection 0 New Connection, Size <br /> ❑Alteration 0 Meter Only, Size <br /> ❑ Repair ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ Cap-off &NOT REQUIRED <br /> ❑ Reconnect Explanation/Utility Permit#: <br /> g,NOT REQUIRED <br /> Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Not Including Cost Estimates) <br /> ❑ New Connection, Size 0 New Connection, Size <br /> ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> SNOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity See attached for reference. <br /> SNOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit) <br /> ❑Water Service Line(behind meter), Size <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> s-NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit <br /> SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES. <br /> ❑.YES,Water:$ [X.YES, $71441 - __41No-r izecv,lZ e'.�7 -•THAc' 9/2016 <br /> Sewer: $ [ See Attached Spre.• --et . - -• a'ons/ .' <br /> lit See Attached Spreadsheet for calculations/credit LS NOT REQUIRED o14 SW-4- o G U ti LIT./ <br /> gr NOT REQUIRED fee. so-r. <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE <br /> ❑ See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> ❑ NOT REQUIRED <br /> Reason: -To d C ocEviC44 a TAP F,me <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> 10 NOT REQUIRED <br /> Worksheet Completed By: : Date: 8� 1 � 2, <br /> i <br /> Worksheet Checked By: �, Date: 3 a�� 8. <br /> 1 <br /> REVISED 8/6/2018 <br />