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�;. PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 2321 ADAMS AVE Permit#: C1809-003 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW SINGLE FAMILY RESIDENCE <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 SERVICE: (Not Including Cost Estimates) <br /> D.,New Connection 0 New Connection, Size <br /> ,Alteration 0 Meter Only, Size <br /> ❑ Repair 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑Cap-off Dit 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 ❑%" Detect Meter Only, Service Size <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> tti:CNOT REQUIRED tpIOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> *OT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit) <br /> ater Servine(behind meter), Size <br /> Backflow PrevceeLintion (Inside Building): ❑ D VA(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 $4(o Arg" 0 YES, $ <br /> Sewer:$ 5, 7 b3 LR-E��r 1544-41.44 <br /> pot. 0 See Attached Spreadsheet for calculations/credit <br /> See Attached Spreadsheet for calculations/credit OT REQUIRED <br /> ❑ NOT ftt QUIRED St'rn .1f` <br /> akOtt. 41 9a`7 _S B to405� 4 J9'6.248,7 : 4°1. g7 <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE <br /> ❑See Attached Letter, 2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> KNOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> EYES, Permit#PW 1tit-e5& <br /> IKStormwater NPDES Tab Completed in TRAKiT pKADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed Byl. "*.Z..—.534—' <br /> Date: t t/2 920/8 <br /> Worksheet Checked By: _AtinAl& Date: l/ O( �eg <br /> 9� <br /> REVISED 8/6/2018 <br />