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4ffrr PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/5/2018 <br /> Permit#: C1802-002 <br /> PROJECT ADDRESS: 30 112TH ST SE <br /> DESCRIPTION OF WORK: NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: 112TH LLC NAME: Don Shaffer <br /> ADDRESS: PO BOX 232 ADDRESS: 3615 188TH ST NW <br /> NORTH LAKEWOOD,WA,98259 STANWOOD,WA,98292 <br /> PHONE: PHONE: 3606527745 <br /> EMAIL: EMAIL: shaferhydro@aol.com <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: Don Shaffer <br /> PHONE: 4253306523 <br /> EMAIL: shaferhydro@aol.com <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? 0 YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> 0 YES—Type (If yes, add to TRAKiT under Revie`er Comments on Bldg Permit and Stamp Drawings) <br /> NO �1 <br /> Explanation: ' ��► A. A•Tho <br /> (Note:Counter Staff to Create Utility Permit for any Wa(cr/Sewer/System D: +lopment Fees) ; 1 �.7 1Lk " <br /> WATER FEES? i � Wt R£E4 bME ffEnt <br /> DOMESTIC SERVICE: "ter."'" 2 an PFxn IRE SERVICE: <br /> EYES—Amount$ f senkt.' 10 YES—Amount$ <br /> 0 Meter Only, 0 Complete Service, Size ,(u 0 3/" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO / SER. ` (NO <br /> Explanation: 4M v>7 s�►vf A, '6 / !)7 h " Explanation: <br /> N R❑ RPBA Needed at premise?-(Plumbing permit for ackflow device needed due to High-Hazard Site per Tim Markham's review) <br /> N� 0 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 /> EYES—Amount$ A KNew Connection, �❑Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ <br /> Explanation: NEkt) 6'� PVC, S (E.- S&wer- a67tnEdm U <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> BYES—Amount$ 9) 6X1, °-9- ❑ See Attached Spreadsheet <br /> NO—No Change of Use/Other ,, A y�� <br /> Explanation: //52 4 11£,u) sFg. ) /10 ofeb (I/G(.eut /01-) <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> �NO t K�rnYlq , pear <br /> 7 <br /> ADDRESS LETTER REQUIRED_? (If yes(new assigned address), print out Address L tter frgqm TRAKiT print Menu and inc Cal <br /> EYES—TYPE S 'See Attached LetterXa/a1E tS a A 1D o1f Copy of Q(Il) <br /> ❑ NO \sew\ cstlar C0 f( -ED 3 E{ U %ICS <br /> PW Reviewer: / / / Date: <br /> . / e:L5laki igOlg <br /> REVISED 10/11/2016 <br />