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44.77- PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/7/2017 <br /> Permit#: PW1707.O2/ <br /> PROJECT ADDRESS: 126:2. 16TH AVE SE �p - 3 <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 1706 — 030 <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 /> ,/ ,'NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for an Water/Sewer/System Development Fees) <br /> WATER FEES? 654leci W shOhri4"E <br /> DOMESTIC SERVICE: • FIRE SERVICE: <br /> ❑YES—Amount$ O o� - 0 YES—Amount$ <br /> 0 Meter Only, 0 Complete Service,Size _• 0 3/4"Detect Meter Only, 0 Fire Service Size <br /> XNO1/ �j NO <br /> Explanation: �4 0 — 03,2_ 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 /> SEWER FEE? --7,01 <br /> e/ �8[YES—Amount$ 79 " XNew 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$_ g79, _ 0 See Attached Spreadsheet / ?57 <br /> .° <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? C1 <br /> ›'YES—Amount$ 2400°" 0 Seeb� Attached Spreadsheet <br /> ❑ NO 4 Qiz9G{%C 'IO Mik 8/7'4. <br /> / ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> . WYES—TYPE S F , See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: 7/J/7 <br /> REVISED 10/11/2016 <br />