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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 332 MADISON ST Permit#: C1903-013 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONVERT SFR&GARAGE TO A DUPLEX BY CONNECTING BLDGS <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 -0 Per Cost Estimate <br /> Alteration 0 Meter Only, Size - 0 Per Cost Estimate <br /> '0 Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity 0 Sewer System Development Fee Total:$ <br /> ❑ Reconnection to stub ABLWater Service Line(behind meter), Size 3/4 " <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RP A or 0 DCVA <br /> ❑ NOT REQUIRED / � ❑ NOT REQUIRED 11 <br /> Explanation/Utility Permit#: VAOS — o l�O Explanation/Utility Permit#: C\C‘o3 <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA SNOT REQUIRED <br /> g-NOT REQUIRED Explanation/Utility Permit#: <br /> "Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> ,SNOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> YES, Stormwater Total: $ "7 fp. to IKYES,Traffic Mitigation Total: $ 24 00 <br /> IiitRoof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> 0 All Hard Surface Fees to be added to Permit# 0 NOT REQUIRED <br /> R See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> hYYES—TYPE: 0 SFR ( DUPLEX 0 ADU 0 INFILL DWELLING 0 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 /> a4;Digital copy attached to permit record, Permit# C' 14103- 013 <br /> git Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> Fil-NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> "kNOT REQUIRED <br /> Worksheet Completed By: ' f • Date: 3/9/26f9 <br /> Worksheet Checked By: Date: SII/201C1 <br /> REVISED 4/24/2019 <br />