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g". PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 10200 19TH AVE SE Permit#: B1804-048 <br /> TENANT: COSTCO FUEL <br /> DESCRIPTION OF WORK: EXPANSION OF COSTCO FUELING FACILITY <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: MESTIC WATER SERVICE: (Not Including Cost Estimates) <br /> ❑ New Connection 0 New Connection, Size <br /> Alteration 0 Meter Only, Size <br /> ❑ Repair ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ Cap-off R(NOT REQUIRED <br /> ❑ Reconnect (A18"68-03 Explanation/Utility Permit#: <br /> ❑ NOT REQUIRED <br /> Explanation/Utility Permit#:Qom'• IA,Ety c.qo.iwr 04_4.1,4 E <br /> air <br /> IRRIGATION SERVICE: (Not Indin Cost Estimates) E SERVICE: (No Including Cost Estimates) <br /> ❑ New Connection, Size 0 New Connection, Size 11 <br /> ❑ Meter Only, Size _ V 3/"Detect Meter Only, Service Size 6 <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA VjEtBackflow Prevention (Outside Building): gDCDA <br /> /a NOT REQUIRED 0 NOT REQUIRED $fig , <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> 14S oc SMIA <br /> A�W TER DEP RT T COST ESTIMATE NEEDED-(Ifyes, PW Reviewer o send cost estimate request to Water Department <br /> r� Yes, Quantity _, See attached for reference.—$p has ' - 6 r( f e,C vi an sit 1 jM c Y ytc) <br /> ❑ NOT REQUIRED j s <br /> ✓Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit) <br /> ❑Water Service Line(behind meter), Size <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> Z NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit),.6 4g <br /> SYSTEM DEVELOPMENT FEES: V(RAFFIC MITIGATION FEES: <br /> �g� <br /> ❑YES,Water: $ KYES, $ 331600•67 Film, TYA isa <br /> Sewer:$ 0 See Attached Spreadsheet for calc�lations/credit !V .SF�/q <br /> ❑See Attached Spreadsheet for calculations/credit �OT REQUIRED <br /> KNOT REQUIRED <br /> Additional Checklists: <br /> ,ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE <br /> ❑ See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits,scan one copy to Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> NOT REQUIRED <br /> I/EIRE SPRINKLERS REQUIRED? <br /> EYES—Type <br /> ❑ NOT REQUIRED <br /> Reason: ci <br /> PUBLIC WORKS PERMIT REQ IRED? <br /> t(YES, Permit#PW 0 -01 3 leADA <br /> R <br /> lattormwater NPDES Tab Completed in TRAKiT eaADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED 1 <br /> Worksheet Completed By: ,_ I brili <br /> Date: 114 <br /> e((6 (t6 <br /> Worksheet Checked By: Date: <br /> REVISED 8/6/2018 <br />