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PUBLIC WORKS <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/23/2017 <br />Permit M - <br />PROJECT ADDRESS: 9911 23RD AVE SE V J ( i 7D3 -� <br />DESCRIPTION OF WORK: BOOSTER STATION REMODEL -SILVER LK WATER & SEWER �� <br />CONTACT INFORMATION: <br />_OWNER: <br />APPLICANT: <br />NAME: SILVER LAKE WATER DIST <br />NAME: <br />[AppName] <br />ADDRESS: 2210 132ND STREET S E <br />ADDRESS: <br />[AppAdd] <br />EVERETT, WA, 98204 <br />[AppCi], [AppSt], [AppZip] <br />PHONE: <br />PHONE: <br />[AppPhone] <br />EMAIL: <br />EMAIL: <br />[AppEmail] <br />CONTACT: ❑ Owner ❑ Applicant ❑Other <br />NAME: DELFEL ERIC <br />PHONE: 2062840860 <br />EMAIL: <br />COMMENTS FROM PUBLIC WORKS REVIEWER: <br />PW Permit Required? ❑ YES XNO <br />Notes: <br />LAND USE PROJECT #: <br />W.O. #: <br />Associated Bldg./PW Permit #: <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 />tKN O <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 />❑ YES — Amount $ ❑ YES — Amount $ <br />❑ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size <br />XNOI NO <br />Explanation: Explanation: <br />❑ RPBA Needed at premise? -(Plumbing permit for backflow device needed due to High -Hazard Site per Tim Markham's review) <br />❑ Water Department Cost Estimate Needed -(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br />Existing Utility Permit # (if applicable): <br />SEWER. FEE? OP <br />YES -- Amount $ .%� __ �1 New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br />❑ NO , <br />Explanation: <br />Existing Utility Permit # (if applicable): <br />S'FtJ � L 1 h`i rife ha; wader- Q Lread� <br />SYSTEM DEVELOPMENT FEE? � ON� � <br />YES -- Amount $ 4Z I Z. ❑ See Attached Spreadsheet `7 0,38 )(6, 518� <br />SS ¢ Z ( Z <br />❑ NO — No Change of Use / Other C-0mc,yKiV1 , X �5 we r�) <br />Explanation: <br />(Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit (if applicable)) <br />TRAFFIC: MITIGATION FEE? <br />❑ YES — Amount $ ❑ See Attached Spreadsheet <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />13 YES — TYPE ❑ See Attached Letter — <br />Y�' O' bJ �-l S 1 7 <br />PW Reviewer: <br />REVISED 10,'11/2016 <br />Date: <br />