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PUBLIC WORKS <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) <br />PROJECT ADDRESS: 12815 19TH AVE SE <br />DESCRIPTION OF WORK: 2 NEW PORTABLE CLASSROOMS <br />CONTACT INFORMATION: <br />OWNER: <br />NAME: EVERETT SCHOOL DIST 2 <br />ADDRESS: 4730 COLBY AVE <br />EVERETT, WA, 98203 <br />PHONE: <br />EMAIL: <br />Date: 10/30/2017 <br />Permit #: PW1710-045 <br />APPLICANT: <br />NAME: ZACK HAM/DYKEMAN <br />ADDRESS: <br />f f <br />PHONE: 4252593161 <br />EMAIL: ZACKH@DYKEMAN.NET <br />CONTACT: ❑ Owner ❑ Applicant ❑Other <br />NAME: [ContactName] <br />PHONE: [ContactPhone] <br />EMAIL: [ContactEmail] <br />COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT #: <br />PW Permit Required? AYES ❑ NO W.O. #: <br />Notes: <br />Associated Bldg./PW Permit #: B 17 f O — n92 <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 />18 NO <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 />❑ YES — Amount $ ❑ YES — Amount $ <br />❑ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, <br />V(NO ANO <br />Explanation: Explanation: <br />❑ Fire Service Size <br />❑ RPBA Needed at premise? -(Plumbing permit for backf/ow device needed due to High -Hazard Site per Tim Markham's review) <br />❑ Water Department Cost Estimate Needed -(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br />Existing Utility Permit # (if applicable): <br />SEWER FEE? <br />❑ YES — Amount $ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br />R NO <br />Explanation: <br />Existing Utility Permit # (if applicable): f <br />SYSTEM DEVELOPMENT FEE? / vP h)AJ 24 <br />RYES — Amount $ 5546- 88 El Attached Spreadsheet See Lam, s+ y�u1 s �v rtG� (.2/ / ]� <br />73 44 <br />❑ NO — No Change of Use / Other .�; I I S > 5 b %S4c cden�-_ = 27 <br />Explanation: Pe r %u1 Ldi73 <br />(Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit (if applicable))�(o Qp Q GV <br />TRAFFIC MITIGATION FEE? vO . <br />,10 YES — Amount $ ❑ See Attached Spreadsheet 2— 037 0 Porta(>(eS <br />❑ NO'3?e Mik, bl^f c k 2w+ca"I L <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />❑ YES — TYPE ❑ See Attached Letter <br />0 <br />PW Reviewer: I Date: <br />�r rk ) I <br />REVISED 1011112016 <br />