Laserfiche WebLink
4". PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/7/2017 <br /> Permit#: PW1707-018 <br /> PROJECT ADDRESS: 12631 16TH AVE SE pf' l <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 7o6 -025 <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 any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: 1.5-f 4(ed Wir ''71/2LCt/ <br /> D° FIRE SERVICE: <br /> ❑YES—Amount$ ❑YES—Amount$ <br /> ❑ Meter Only, 0 Complete Service, Size • 0%" Detect Meter Only, 0 Fire Service Size <br /> AINO / / NO <br /> Explanation: v /4,0 to — 03 g 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 /> EWER FEE? 00 <br /> ,Z'YES—Amount$ 79� , New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> IVEI YES Amount$ /4` 947 0 See Attached Spreadsheet 2g45 :7�J <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? rJ <br /> / 'YES—Amount$ 24000 0 SeebAttached Spreadsheet <br /> ❑ NO /� ,Se efrna i 170 Kka VA-DDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> tiKrYES—TYPE ,' F ,(See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: 7 -g--/7 <br /> REVISED 10/11/2016 <br />