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gn. PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 1921 COLBY AVE Permit#: C1807-005 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW CONSTRUCTION OF A DUPLEX <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 El-.New Connection, Size f" <br /> ❑Alteration 0 Meter Only, Size <br /> ❑ Repair 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ Cap-off 0 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 0%" Detect Meter Only, Service Size <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> la NOT REQUIRED El-NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#:_ _ <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> }-NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit) <br /> II-Water Service Line(behind meter), Size 1" <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(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 /> AYES,Water:$ 5� (0 23 RYES, $ 4,800 <br /> Sewer:$ $,.. i3 �� ce•cPE-f ❑ See Attached Spreadsheet for calculations/credit <br /> 0 See Attached Spreadsheet for calculations/credit 0 NOT REQUIRED <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> 04-YES—TYPE DL eL E..% <br /> ®.See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> IE-Digital copy attached to permit record, Permit#' i?' i►BIO- 04 <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> III-NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW /8/0 -1308 <br /> ELStormwater NPDES Tab Completed in TRAKiT FADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> 0 NOT REQUIRED <br /> Worksheet Completed By: Date: /6/2// <br /> • \ ( <br /> Worksheet Checked By: ;�(1_ ! /AL. _(kLL l n <br /> Date: (fl I� 'W� 6 <br /> REVISED 8/6/2018 <br />