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PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 1410 HOLLOW DALE PL Permit#: C1808-005 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADD A SECOND STORY AND CONVERT SFR TO DUPLEX(STACKED) <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 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ Cap-off OT REQUIRED <br /> ❑ Reconnect xplanation/Utility Permit#: <br /> e_ <br /> NOT REQUIRED <br /> xplanation/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 0 Backflow Prevention (Outside Building): 0 DCDA <br /> itKNOT REQUIRED1„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 /> ig.NOT 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 /> KNOT 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 /> IVES,Water: $ - P M AYES, $ 2.}4 0 <br /> Sewer:$ —61-~ ...h ll> ,,4o S?dtz,•..l ❑ See Attached Spreadsheet for calculations/credit <br /> 0 See Attached Spreadsheet for calculations/credit �,dyf'1t°I 0 NOT REQUIRED <br /> !\ OT REQUIRED <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 ToVPc.E.,! <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# C.l80 9- oOS <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> (g.NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> 0 Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> KNOT REQUIRED <br /> Worksheet Completed By: Date: ///L f/2o/$ <br /> Worksheet Checked By: 1i Date: 2 Z0� <br /> Ah il9l 8 <br /> REVISED 8/6/2018 <br />