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� PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 2325 ADAMS AVE Permit#: C1810-012 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW SFR <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 /> ANITARY SEWER: p9MESTIC WATER SERVICE: (Not Including Cost Estimates) <br /> d// <br /> New Connection New Connection, Size 3 11. <br /> o Alteration 0 Meter Only, Size <br /> ❑ Repair 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ Cap-off 0 NOT REQUIRED <br /> ❑ Reconnect Explanation/Utility Permit#: <br /> ❑ NOT REQUIRED <br /> Explanation/Utility Permit#: • <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Not Including Cost Estimates) <br /> ❑ New Connection, Size 0 New Connection, Size <br /> ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size <br /> Backflow Prevention (Outside Building): 0 DCVA KNOT REQUIRED NOT REQUIRED <br /> planation/Utility Permit#: xplanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> KNOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit) <br /> i Water Service Line(behind meter), Size 3 /411 <br /> •'Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> ❑ NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> YES,Water: $ —3-8 er{d CV-���r ►,YES, $ 2.4D0 <br /> Sewer: $ ✓ 1 640 See Attached Spreadsheet for calculations/credit <br /> - See Attached Spreadshe-t f.r «:Iculations/credit J 0 NOT REQUIRED <br /> ❑ NOT REQUIRED S2 U'i ` s 2131C\ 2e <br /> Hgl [o[ <br /> Additional Checklists: <br /> QpDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES- PE Sr V. 0 Z.o?4t v.4 pro Pga.a.r I w►-r14 'BA LA SOtiEI" <br /> ee Attached Letter,2 copies(Permit Techs to issue one copy to <br /> app <br /> plicant with permits, scan one copy to Jeffrey Marks) <br /> Digital copy attached to permit record, Permit# Clem- 0 12- <br /> 0 <br /> Z❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> NOT REQUIRED <br /> eason: <br /> IlUBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW iISil - 05 2_ <br /> ►�/Stormwater NPDES Tab Completed in TRAKiT `I\ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT QUIRED /_ <br /> ��''�./� %�_1 ///24o'b <br /> Worksheet Completed By: t<�. _- � � ��I Date: <br /> Worksheet Checked By: "��/ Date: ��/Z9) ®gip- <br /> �e <br /> REVISED 8/6/2018 / <br />