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14"rPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 5/19/2017 <br /> 331 Permit#: C1705-018 <br /> PROJECT ADDRESS: �WETMORE AVE BLDG 2 <br /> DESCRIPTION OF WORK: CONSTRUCT DUPLEX (A � ) <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: MAJLESY NOSRAT NAME: OWNER <br /> ADDRESS: 3319 WETMORE AVE SE ADDRESS: <br /> EVERETT,WA,98201 , , <br /> PHONE: PHONE: <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant pother <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?(YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: POJ R65-'031 <br /> 031 <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> XNO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> /DOMESTIC SERVICE: FIRE SERVICE: <br /> V RYES—Amount$ �(�100x h ❑YES—Amount$ <br /> 0 Meter Only, [Complete Service, Size 1 0 3/4"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO NO <br /> Explanation: Explanation: <br /> N,{4❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> Ott❑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 /> EWER FEE? <br /> YES—Amount$ -90,84 <br /> *New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> YSTEM DEVELOPMENT FEE? <br /> OYES—Amount$ la 1 -q-3 - = 0 See Attached Spreadsheet <br /> ❑ NO No Change of Use/Other <br /> Explanation: )I E,00 DO PPE <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> v-TRAFFIC MITIGATION FEE? <br /> YES—Amount$ 7,$(� <=° 0 See Attached Spreadsheet <br /> ❑ NO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter f •m TRA IT Pciintt Menu and include) <br /> S <br /> YES—TYPE DO (See Attached Letter ..SCA/ 0 , 1� <br /> El `IU <br /> NO 331C1 t�U din ! U n liS ,6Coq 03011Wld r - <br /> PW Reviewer: I / L Date: <br /> / I 2oC- <br /> REVISED 10/11/2016 <br />