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_ PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 2219 PINEHURST AVE A & B Permit#: C1812-013 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONSTRUCT 2-UNIT DUPLEX ON VACANT LOT <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 SERVI9E:(Attach Calculation& Cost.) <br /> ❑ New Connection to main plus connections to building 2 .New Connection, Size 30' -0 Per Cost Estimate <br /> ❑Alteration t Iao _o 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair • Water System Development Fee Total: $ 95 7.0 0 <br /> ❑ Cap-off, quantity , 03,,,oat Sewer System Development Fee Total: $ 5 /2 f , oo <br /> IgReconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 1�V ❑ Backflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED Oft..Far , 0 NOT REQUIRED <br /> Explanation/Utility Permit#: d111t/f (MIT P 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: $ ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA +JOT REQUIRED <br /> .NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/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 /> ANOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> FL.NOT REQUIRED <br /> Building Permits (Note:Permit Technicians t add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES:*`t YES, Stormwater Total: $ 9 4o.S$ PINES,Traffic Mitigation Total:$ I$O 0. 00 <br /> kSee Attached Spreadsheet for calculations 0 See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED. (f yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> tit YES—TYPE: 0 SFR DI(DUP X 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> +l See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> I%Digital copy attached to permit record, Permit# <br /> III-Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE S'0"INK RS REQUIRED? <br /> ❑YES— .,.. <br /> ❑NOTR 'Ab ED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> LYES, Pemit#PW /812 -o(o4 <br /> Stormwater NPDES Tab Completed in TRAKiT Ig-ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: ! _''/ Date: 3 7, /2e /4 <br /> Worksheet Checked By: � '/ , Date: 3/12 7)6(1 <br /> REVISED 2/22/2019 <br />