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4E77 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/30/2017 <br /> Permit#: f3 PW1710-046 <br /> PROJECT ADDRESS: 10901 27TH AVE SE Jo� Rev reed <br /> DESCRIPTION OF WORK: 1 NEW PORTABLE <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: EVERETT SCHOOL DIST 2 NAME: ZACK HAM/DYKEMAN <br /> ADDRESS: 4730 COLBY AVE ADDRESS: <br /> EVERETT,WA,98203 <br /> PHONE: PHONE: 4252593161 <br /> EMAIL: EMAIL: ZACKH@DYKEMAN.NET <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? 0 YES )4 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br /> 0 YES—Type (If yes,add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> g NO <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$ 0 YES—Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0%"Detect Meter Only, 0 Fire Service Size <br /> 1%1 NO 0 N <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-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> ❑YES—Amount$ 0 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 121 NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> ,NO—No Change of Use/Other LL� <br /> Explanation: S(LVev' Lake L,ucrTer cu) Sewek" <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> 0 N <br /> See e-kia iL -to lvl i ke. brick <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Lotter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE 0 See Attached Letter <br /> NO <br /> PW Reviewer: Date: <br /> Kirk I1 -a-17 <br /> REVISED 10/11/2016 <br />