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EVERETT '# • <br /> in WASHINGTON PUBLIC • <br /> WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 12115 19TH AVE SE CLUBROOM Permit#: PW2008-021 <br /> TENANT: AUKUM MANAGEMENT LLC <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW CONCRETE PADS, NEW ADA PARKING SPACES <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 /elected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Att.ch Calculation&Cost Est.) <br /> ❑ New Connection to main plus connections to building 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only,Size - A Per Cost Estimate <br /> ❑ Repair 0 Water System Developmen ee Total:$ <br /> ❑ Cap-off, antity ❑Sewer System Developm: t Fee Total:$ <br /> ❑Reconn ction to stub 0 Water Service Line(be d meter), Size <br /> CIBackw ter Valve 0 Backflow Prevention (• tside Building): 0 RPBA or❑ DCVA <br /> NOT SQUIRED tg NOT REQUIRED <br /> Explan tion/Utility Permit#: Explanation/Utility Pe, it#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (i ach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑Meter Onl Size ❑3/4" Detect NI-ter Only, Service Size <br /> ❑Water Sy tem Development Fee Total:$ 0 Backflow P -vention (Outside Building): ❑ DCDA <br /> ❑ Backflo Prevention (Outside Building): 0 DCVA I'a NOT RE* IRED <br /> NOT QUIRED Explanatio Utility Permit#: <br /> Explana on/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> 0 Yes, Quantity , See attached for reference. <br /> li NOT REQUIRED <br /> Plumbing ermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow evention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> 124 NOT RE UIRED <br /> B ilding Permits (Note:Permit Technicians to add all items selecte elow to associated Building Permit) <br /> TORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC IGATION FEES: <br /> / 'YES, Stormwater Total: $ 141,11 0 YES raffic Mitigation Total: $ <br /> / ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) See Attached for calculations/credit <br /> ktAII Hard Surface Fees to be added to Permit# ?W 2-00i -0 2l tri OT REQUIRED <br /> 12(See Attached Spreadsheet for calculations/credit <br /> 0 NOT REQUIRED <br /> itional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: � SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> CI See ''tached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Di.'al copy attached to permit record, Permit# <br /> ❑ S-ved to Address Folder in Development Tech File <br /> 15(NOT R '<UIRED <br /> FIRE SPRIN LERS REQUIRED? <br /> ❑YES—T e <br /> SNOT QUIRED <br /> o <br /> gyBES LIC WORKS PERMIT REQUIRE <br /> , Perm�it#PW D?7-AOf��0 <br /> "Stormwater NPDES Tab Completed in TRAKiT X ADA Tab Completed in TRAKiT inspections Added in TRAKiT <br /> NOT REQUIRED <br /> �, <br /> Works eet Completed By: 44k Date: tO/D1I20 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />