9010 4TH AVE W 2020-06-15 - Laserfiche WebLink

"1,--A PUBLIC WORKS REVIEW WORKSHEET PROJECT ADDRESS: 9010 4TH AVE WEST Permit#: C1812-009 TENANT: [TenName] DESCRIPTION OF WORK: NEW SFR PW Reviewer to select all that apply below: Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) SANITARY SEWER: U fqo, 0?/7 Wg0031MESTIC WATER SERVICE: SAttach Calculation&Cost Est.) ,/, New Connection to main plus Y connections to building ✓(New Connection, Size 3/4 - 0 Per Cost Estimate ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate ❑ Repair $Water System Development Fee Total: $ 3, 957. oo ❑ Cap-off, quantity 6/ ,DSewer System Development Fee Total: $ S. 12 1. 00 ❑ Reconnection to stub IO Water Service Line(behind meter), Size ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA ❑ NOT REQUIRED 0 NOT REQUIRED Explanation/Utility Permit#: Explanation/Utility Permit#: IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size ❑Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA ❑ Backflow Prevention (Outside Building): 0 DCVA %NOT REQUIRED AtNOT REQUIRED Explanation/Utility Permit#: Explanation/Utility Permit#: WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) ❑Yes, Quantity , See attached for reference. A,NOT REQUIRED Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) KNOT REQUIRED Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: V pit YES, Stormwater Total: $ Co 2.2. oo e,(40(1'001 ❑YES,Traffic Mitigation Total: $ xSee Attached Spreadsheet for calculations 0 See Attached Spreadsheet for calculations/credit ❑ NOT REQUIRED NOT REQUIRED Additional Checklists: ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) V AYES—TYPE: 1KSFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) Digital copy attached to permit record, Permit# 'PW I9o3-014 Saved to Address Folder in Development Tech File ❑ NOT REQUIRED FIRE SPRINKLERS REQUIRED? ❑YES—Type KNOT REQUIRED Reason: PUBLIC WORKS PERMIT REQUIRED? YES, Permit#PW a 4 o 3- 19 lk[Stormwater NPDES Tab Completed in TRAKiT ikADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT ❑ NOT REQUIRED Worksheet Completed By: a Date: cI8 19 / Worksheet Checked By: !4 i Date: 31g/17/016k REVISED 2/22/2019