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0477 PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 5701 1ST AVE SE Permit#: PW1808-062 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: PUT METALLIC SERIES CORTEN STEEL PLANTER BOX <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 /> ❑ 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 KNOT REQUIRED <br /> ❑ Reconnect planation/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 03/4" Detect Meter Only, Service Size <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA 111 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ NOT REQUIRED t 'NOT 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 /> KNOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit) <br /> ❑Water Service Line(behind meter), Size ' <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> KNOT 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: $ 0 YES, $ <br /> Sewer: $ 0 See Attached Spreadsheet for calculations/credit <br /> ❑ See Attached Spreadsheet for calculations/credit "NOT REQUIRED <br /> KNOT REQUIRED <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 /> 0 Digital copy attached to permit record, Permit# <br /> 171,NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> NOT REQUIRED <br /> son: <br /> PUBLIC WORKS PERMI REQUIRED? <br /> ❑YES, Permit#PW ( W O$ -• O t <br /> 0 Stormwater NPDES Tabiiiiiii pleted in TRAKiT n ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> J .NOT REQUIRED arr <br /> Worksheet Completed By: I=�� -'`jo, Date: v 9 <br /> Worksheet Checked By: _..,... ,".......•`.'e'7,.4,.. , Date: 9' / ¢ i <br /> REVISED 8/6/2018 <br />