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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 5/2/2018 <br /> Permit#: PW1805-006 <br /> PROJECT ADDRESS: 4620 SEAHURST AVE <br /> DESCRIPTION OF WORK: CONNECT TO EXTG SEWER AND WATER <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: THOMPSON PAUL A&H JOAN NAME: PAUL THOMPSON <br /> ADDRESS: 15028 228TH ST SE ADDRESS: 15028-228th S.E. <br /> SNOHOMISH,WA,98296-5479 SNOHOMISH,WA,98296 <br /> PHONE: PHONE: 2069203090 <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: THOMPSON CHRIS <br /> PHONE: 2069201325 <br /> EMAIL: JANRISCONSTRUCTION@GMAIL.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: 'I 001 <br /> — <br /> PW Permit Required?KYES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: t2/pOS OO ? <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> AYES—Type P (If yes,add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation - -- _ -` 1 I ok 1 $ _ea el it L $ th, <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> �]YES—Amount$ 0 YES—Amount$ <br /> 0 Meter Only, 0 Complete Service,Size 0 3/" Detect Meter Only, 0 Fire Service Size <br /> 1100 r1 �NO <br /> Explanation: 6X S jyft� 1� 1 u4shi 4 Explanation: <br /> ���❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> 00 Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> "YES—Amount$ �OLL.22 0 New Connection, 0 Alteration/Repair, ' Cap-off€Reconnect <br /> ❑ <br /> Explanation: eS4Uto \ &j. (A) &r+ <br /> Existing Utility Permit#(if applicable): 111 <br /> SYSTEM DEVELOPMENT FE ? <br /> RYES—Amount$ r 0 See Attached Spreadsheet <br /> ❑ NO—No ChangeW sem nt�h F LC/AAA <br /> ` ` =4 SIZ' sEw = 4� '�� <br /> Explanation: NEW ) <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> EYES—Amount$ `" ' 0 See Attached Spreadsheet <br /> ❑ NO S pial <br /> ADDRESS LET ER REQUIRED? (If yes(new assigned address), print out Address Letter rom RAKi,T'`Pr_igt n and incluudye, <br /> 1d YES—TYPE S�, See Attached Letter)i OflE oo��� a� a l �p_ eW �" <br /> ❑ NO 462© S \S(`.QXL c0C6�ul �v �k� u J ingAks <br /> PW Reviewer: Date: 0 <br /> I / 7-7'951 <br /> REVISED 10/11/2016 <br />