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LE V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> E WASHINGTON <br /> PROJECT ADDRESS: 10317 HOLLY DR Permit#: B1904-040 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CREATE AFH IN SFR,CONVERT LIVING ROOM INTO 2 BEDROOMS <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 ' RVICE: (Attach Calculation& Cost Est.) <br /> ❑ New Connection t• main plus connections to building 0 New Connectio , Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, e -0 Per Cost Estimate <br /> ❑ Repair 0 Water Sys • Development Fee Total:$ <br /> ❑ Cap-off, q tity 0 Sewer S tern Development Fee Total: $ <br /> ❑ Reconn- ion to stub 0 Water. ervice Line(behind meter), Size <br /> ❑ Back er Valve 0 Bac ow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> -NO 'EQUIRED JN• REQUIRED <br /> Expl ation/Utility Per #: E anation/Utility Permit#: <br /> IRRIGATION SE- ICE: (Not Including Cost Estimates) FIRE SERVIC . (Attach Cost Estimate/Request for Reference) <br /> ❑ New Conne, ion, Size 0 New Co ection, Size - 0 Per Cost Estimate <br /> ❑ Meter On Size 0%"De ct Meter Only, Service Size <br /> ❑Water ' stem Development Fee Total: $ 0 Bac ow Prevention (Outside Building): 0 DCDA <br /> ❑ Bac 'ow Preve 'on (Outside Building): 0 DCVA (514,1 REQUIRED <br /> 19-RIP REQUI D Ex anation/Utility Permit#: <br /> •anation/ ility Permit#: <br /> WATER PARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, uantity , See attached for reference. <br /> I N REQUIRED <br /> Plumbing ermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflo 'revention (Inside Building): 0 DCVA(for Domestic service) ❑RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> SNOT ' QUIRED <br /> Bui ding Permits (Note:Permit Technicians to add all items selected below to associated Building Permi <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITI - ION FEES: <br /> YES, Stormwater Total: $ 4 9. '74 0 YES,Tr.•`c Mitigation Total: $ <br /> LJ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 e Attached for calculations/credit <br /> •II Hard Surface Fees to be added to Permit#'�110 4-o 4-c.) )111\le REQUIRED <br /> ■ See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checkli-- s: <br /> ADDRESS LETTER - QUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: ■' FR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑See °'ttached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ D'2ital copy attached to permit record, Permit# <br /> ❑ saved to ••dress Folder in Development Tech File <br /> rkNOT "QUIREr <br /> FIRE SPRIN RS REQUIRED? <br /> ❑YES—T e <br /> pLNOT ' QUIRED <br /> Reaso-' <br /> PUBLIC WOR.- PERMIT REQUIRED? <br /> ❑YES, Per, t#PW <br /> , Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> r 4lo -EQUIRED <br /> orksheet Completed By: �' ./ Date: (,/7/2o/9 <br /> �Worksheet Checked By: 4•11 %► �'� Date: � zo <br /> REVISED 4/24/2019 <br />