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4ErrPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/7/2017 <br /> Permit#: PW1707 Of <br /> PROJECT ADDRESS: 126' 16TH AVE SE t O 5 <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SINGLE FAMILY RESIDENCE <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: PACIFIC HEIGHTS HOMES LLC NAME: PACKARD DALE <br /> ADDRESS: 620 SE EVERETT MALL WAY STE.35 ADDRESS: <br /> EVERETT,WA,98208 , , <br /> PHONE: PHONE: 4252380936 <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PACKARD DALE <br /> PHONE: 4252380936 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#:C / 7e9 6 " OZ/ <br /> FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br /> 0 YES—Type (If yes,add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> XI'NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> L551IL a/ with° /"LLt- <br /> DOSERVICE:EFIRE SERVICE: <br /> ❑YES—Amount$ .012—v ❑YES—Amount$ <br /> ❑ Meter Only, 0 Complete Service, Size _• 0 3/"Detect Meter Only, 0 Fire Service Size <br /> XNO )3(NO <br /> Explanation: (//406.- I/30 Explanation: <br /> ❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> ❑Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> Vr SEWER FEE? -7".) <br /> )iirYES—Amount$ 7 2 ' )(New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> 'SYSTEM DEVELOPMENT FEE? <br /> ❑YES—Amount$_ , i4-7 0 See Attached Spreadsheet 281-5 <br /> :f1 <br /> ❑ NO—No Change of Use I Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> 'AFFIC MITIGATION FEE? 0 <br /> 'YES—Amount$ 2400 0 See Attached Spreadsheet <br /> ❑ NO /C. Sea ei'✓1R%C `to Mrk 8,7 Ck <br /> (ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> I$'YES—TYPE s' P ,KSee Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: 7-11-17 <br /> REVISED 10/11/2016 <br />