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�, PUBLIe WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 1910 74TH ST SE Permit#: C1808-007 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW DUPLEX <br /> ()N1• <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: V OMESTIC WATER SERVI E: (Attach Calculation&Cost Est.) <br /> w Connection to main plus t connections to building $Qlew Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair ater System Development Fee Total: $ 957 oo <br /> o Cap-off, quantity Sewer System Development Fee Total:$ 46 /2.1. 00 <br /> ❑ Reconnection to stub Backflow Prevention (Outside Building): D R1PBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <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 0-NOT REQUIRED <br /> J-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 /> KNOT REQUIRED <br /> umbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit) <br /> .Water Service Line(behind meter), Size3 4 la h <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(forbomestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> ❑ NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all iters selected below to associated Building Permit) <br /> /TORMWVCi <br /> ATER SYSTEM DEVELOPMENT FEES: AFFIC MITIGATION FEES: A't-wt-tr-e4 > ° <br /> ❑YES, Stormwater Total: $ SEC L,fr.3,i-r ,At 0 YES,Traffic Mitigation Total:$ ""1" <br /> 0 See Attached Spreadsheet for calculations 0 See Attached Spreadsheet for calculations/credit <br /> OT REQUIRED OT REQUIRED <br /> Additional Checklists: <br /> ye6RESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> LYES-TYPE: 0 SFR ,DUPLEX 0 ADU ❑ 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 /> I, Bigital copy attached to permit record, Permit# <br /> 12i-Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> IL 0 YES-Type <br /> N SNOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> FEES,Permit#PW !moo 9 -O7 0 <br /> 01-Stormwater NPDES Tab Completed in TRAKiT 'SDA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: <br /> Date: //2J /2.6/4 <br /> // <br /> Worksheet Checked By: ,-i /U / '' f/ Date: /70.3720// <br /> 20/cl <br /> REVISED 1/7/2019 <br />