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wr - Arn rine <br /> PUBLIC WORKS <br /> 1 REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/7/2017 <br /> Permit#: PW1707.-020 <br /> PROJECT ADDRESS: 126:2716TH AVE SE ' <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 170& " 029 <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ❑YES-Type (If yes,add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ✓ XINO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: %S- /5.4(e (4.17-r4°'-'7L/LCtl' <br /> ofl FIRE SERVICE: <br /> ❑YES-Amount$ �^ ❑YES-Amount$ <br /> 0 Meter Only, 0 Complete Service, Size _• 0%"Detect Meter Only, 0 Fire Service Size <br /> XNO )3(NO <br /> Explanation: 6./14 o b- 03 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? 00 <br /> %YES-Amount$ 7� )(New Connection, ❑Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES-Amount$_ 799' _ 0 See Attached Spreadsheet / 957 <br /> ❑ NO-No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> v TRAFFIC MITIGATION FEE? 00 <br /> 'YES-Amount$ 2400 0 See Attached Spreadsheet <br /> ❑ NO .Se efrnet%L TO M;ka8'i c <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ✓ krYES-TYPE .S P/ ,KSee Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: 7 1 --%7 <br /> REVISED 10/11/2016 /�,{ <br />