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4' PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 11/27/2017 <br /> Permit#: PW1711-032 <br /> PROJECT ADDRESS: 5601 Sod SY-Se <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: D&G HOPKINS LLC NAME: GLACIER VIEW PROPERTIES <br /> ADDRESS: 13220 47TH AVE SE ADDRESS: 10121 EVERGREEN WY STE 25-165 <br /> MILL CREEK,WA,98012 EVERETT,WA, 98204 <br /> PHONE: PHONE: <br /> EMAIL: EMAIL: <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: ALLEN RON <br /> PHONE: 4255084380 <br /> EMAIL: ronalien3431@yahoo.com <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?14 YES 0 NO W.O.#: // <br /> Notes: Associated Bldg./PW Permit#: C/9/1—'OD 7-- <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> iv EYES-Type 1% k:. (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> 0N <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> vitYES-Amount$ 3/ 0/6 . b a h 0 YES-Amount$ <br /> 0 Meter Only, 1 Complete Service, Size L 0 3/4' Detect Meter Only, 0 Fire Service Size <br /> ❑ NO R(NO <br /> Explanation: Explanation: <br /> Nno RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> 0 Pi❑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? <br /> /'EYES-Amount$ '�",:' 'ic•e- IA/New 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$ 4, 6) 2 it x I 'See Attached Spreadsheet <br /> ❑ NO-No Change of Use/Other <br /> Explanation: N A J SFS 1000?,OOOsp <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> Ig YES-Amount$ 2,�'6 --7:-.70 0 See Attached Spreadsheet <br /> ❑ NO <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print outAddr9ss Letter fro T iT)PrinnttrMenu and include) <br /> �®YES-TYPE � ?'' - See Attached Letter _ A hriv Ib /W pi-2.7n': <br /> ❑ NO -SCO"76S d <br /> PW Reviewer: -)`f \G��j� Date: <br /> 7'12. - �� ZAZ $ <br /> REVISED 10/11/2016 <br />