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0 0 <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 12115 19TH AVE SE GAZEBO Permit#: B2010-033 <br /> TENANT: AUKUM MANAGEMENT LLC <br /> DESCRIPTION OF WORK: NEW EXTERIOR GAZEBO ADDED NEAR POOL DECK <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: (Attach Calculation&Cost Est.) <br /> ❑ New Connection to main plus connections to building 0 New Connection, Size -❑ Per Cost Estimate <br /> ❑Alteration ❑ Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System D elopment Fee Total:$ <br /> ❑ Cap-off,qu ity 0 Sewer Syst Development Fee Total: $ <br /> ❑ Reconne 'on to stub 0 Water S Ice Line(behind meter), Size <br /> ❑ Backw r Valve ❑ Backfl Prevention (Outside Building): 0 RPBA or❑ DCVA <br /> jNOT QUIRED XNOT EQUIRED <br /> Expla tion/Utility Permit#: Expla tion/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVIC : (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connec' n, Size 0 New Con ction, Size -❑ Per Cost Estimate <br /> ❑ Meter Onl Size ❑3/" Det t Meter Only, Service Size <br /> ❑Water S tem Development Fee Total:$ 0 Back w Prevention (Outside Building): 0 DCDA <br /> ❑ Backfl Prevention (Outside Building): 0 DCVA )R'NO REQUIRED <br /> ,(NO EQUIRED Expl nation/Utility Permit#: <br /> Exp ation/Utili Permit#: <br /> WATER DEP RTMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qu tity , See attached for reference. <br /> KNOT QUIRED <br /> Plu ing 'ermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflo ' revention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA or Domestic service) 0 DCDA(for Fire service) <br /> lik NOT -`QUIRED <br /> wilding Permits (Note: -ermit Technicians to add all items selected belo associated Building P- it) <br /> STORMWATER SYSTEM D. ELOPMENT FEES: TRAFFIC MI GATION FEES: <br /> XYES, Stormwater Total: ': (01.2Z YES,Tr. is Mitigation Total: $ <br /> ❑ Roof Only Fee on, Idg Permit(ground hard s rfaces fee on PW Permi r ❑ e Attached for calculations/credit <br /> All Hard Surfac ees to be added to Permit 6200 - 033 NO.'REQUIRED <br /> (See Attached. preadsheet for calculations/ redit <br /> NOT REQUIRE' <br /> Additional hecklists: <br /> ADDRESS L TER REQUIRED? (If yes (new assigned address), print out Addr s Letter from TRAKiT Print Menu and include) <br /> ❑YES—TY'E: ❑ SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <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 /> El Saved to Address Folder in Development Tech File <br /> �, N• REQUIRED <br /> FIRE SP INKLERS REQUIRED? <br /> ❑YES—Type <br /> VeN REQUIRE" <br /> Reason: <br /> PUBLIC W. 'KS PERMIT REQUIRED? <br /> ❑YES, P- mit#PW <br /> ,'■ Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> )4N• REQUIRED <br /> Worksheet Completed By: A 4\ Date: u3(7-$ir20 <br /> Worksheet Checked By: _J )+- Date: n id 0/211 <br /> REVISED 11/27/2019 <br />