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/ PUBLIC WORKS .REVIEW WORKSHIIII <br /> RT <br /> PROJECT ADDRESS: 1910 74TH ST SE Permit#: C1808-007 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW DUPLEX ColNI A <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 /> ANITARY SEWER: ' QMESTIC WATER SERVICE:fAttach Calculation&Cost Est.) <br /> v/p <br /> New Connection to main plus connections to building KNew Connection, Size 3/4 -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> O Repair Water System Development Fee Total: $ 3,951 pa <br /> ❑ Cap-off, quantity JZSewer System Development Fee Total: $ 5, i 2/. co <br /> ❑ Reconnection to stub 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> .f�'IRRIGATION SERVICE: (Not Including Cost Estimates) p/�'FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> NNlll 0 New Connection, Size II 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: $ ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA O"NOT REQUIRED <br /> OT REQUIRED Explanation/Utility Permit#: <br /> xplanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes,Quantity , See attached for reference. <br /> J IOT REQUIRED <br /> dumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit) <br /> 0-Water Service Line(behind meter), Size 3/4 <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 /> TORMWATER SYSTEM DEVELOPMENT FEES: 1„AfIAFFIC MITIGATION FEES: <br /> YES, Stormwater Total: $ 1, 2o+a. 93 gi—YES,Traffic Mitigation Total: $ I B00. 00 <br /> 1.See Attached Spreadsheet for calculations 0 See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED' 0 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 /> ES—TYPE: 0 SFRPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> See Attached L itter, 2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> 'igital copy attached to permit record, Permit# 'ham t b o 8- o, <br /> ,Saved to Address Folder in Development Tech File <br /> O NOT REQUIRED <br /> IOFIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> $ NOT REQUIRED <br /> Reason: <br /> VIUBLIC WORKS PERMIT REQUIRED? <br /> rYES, Permit#PW 1%o A• 010 <br /> TOStormwater NPDES Tab Completed in TRAKiT 'CADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> -- <br /> Worksheet Completed B — Date: / 123/2o t9 <br /> rr <br /> !�/� i' <br /> Worksheet Checked By: • / /L�l Date: 6/03721V? <br /> REVISED 1/7/2019 <br />