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grr PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 1205 50TH ST SW Permit#: C1807-003 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONSTRUCT GARAGE/PLUMB IN FULL BATHROOM <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: DOMESTIC WATER SERVICE: (Not Including Cost Estimates) <br /> ❑ New Connection 0 New Connection, Size <br /> litAlteration 0 Meter Only, Size <br /> ❑ Repair ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ Cap-off 0.-NOT REQUIRED <br /> ❑ Reconnect Explanation/Utility Permit#: <br /> ❑ NOT REQUIRED <br /> Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Not Including Cost Estimates) <br /> ❑ New Connection, Size 0 New Connection, Size <br /> ❑ Meter Only, Size ❑3A"Detect Meter Only, Service Size <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA 0 Backflow Prevention (Outside Building): 0 DCDA <br /> SNOT REQUIRED MOT REQUIRED <br /> Explanation/Utility Permit#: 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 /> *NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit) <br /> UkVater Service Line (behind meter), Size 3 /4 n <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 /> SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ❑YES,Water: $ 0 YES, $ <br /> Sewer: $ 0 See Attached Spreadsheet for calculations/credit <br /> ❑ See Attached Spreadsheet for calculations/credit SNOT REQUIRED <br /> 1#-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 /> ❑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 /> 1111-NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> p-NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> EYES, Permit#PW /$IO -003 <br /> IitStormwater NPDES Tab Completed in TRAKiT SADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet ��B :Completed -�� <br /> p Y Date: /O//�� <br /> \ \ <br /> Worksheet Checked By: i (e Date: If) I \,t1:1REVISED 8/6/201S <br />