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477. i <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 6620 COMMERCIAL AVE Permit#: PW1807-019 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW BATHROOM ADDITION TO SFR, DUPLEX ADDITION <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 /> 07+ pl New Connection ,‘ 0 New Connection, Size <br /> UI Alteration Gx jird K 6 '4 '1" 4i/� �C 0 Meter Only, Size <br /> ❑ Repair J ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> �U/ <br /> ❑ Cap-off ,top Y' b v 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 3/" Detect Meter Only, Service Size <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> NOT REQUIRED Fl 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 /> NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) ,`!�� <br /> YSTEM DEVELOPMENT FEES: RAFFIC MITIGATION FEES: Z <br /> EA YES,Water: $ Zi 13 . S gt'a. IF YES, $- _a , q e.o . <Sre 1Z41.00_`6Zg77 <br /> Sewer: $ I I dS, '1C, Z 0 See Attached Spreadsheet for calculation'. c -di <br /> Epee Attached Spreadsheet for calculations/credit 0 NOT REQUIRED <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> 1/ DDRESS LETTER REQUIRE. (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> p YES—TYPE 24/Pt..24/Pt.. w . <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 /> G'IOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW f QJO i A <br /> I Stormwater NPDS Tab ompleted in TRAKiT I'8(ADA Tab Completed in TRAKiT 0 Ins ections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: VAS" _ -�� Date: t ) • <br /> / J / <br /> Worksheet Checked By: V t' ha_ / f ,E Date: i b i <br /> REVISED 8/6/2018 <br />