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04"77. PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/13/2017 <br /> Permit#: PW1709-021 <br /> PROJECT ADDRESS: 1425 RUCKER AVE) U IJ1 IT A <br /> DESCRIPTION OF WORK: NEW SFR IN FRONT OF FUTURE DADU <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: WEIR BRENT A&DAYNA M NAME: WEIR BRENT A&DAYNA M <br /> ADDRESS: 824 148TH LN SE ADDRESS: 824 148TH LN SE <br /> BOTHELL,WA,98012 BOTHELL,WA, 98012 <br /> PHONE: PHONE: <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: WEIR BRENT A&DAYNA M <br /> PHONE: <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: A/C8/ F 005 <br /> PW Permit Required? YES 0 NO / ( W.O.#: R/ <br /> Notes: � /ZYWEJ 11 x l elm In'f�LE ala Associated Bldg./PW Permit#: C11-07 -038 <br /> Pk) p m, -- fOT od o2/ <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> YES-Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> 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 3/4" Detect Meter Only, 0 Fire Service Size <br /> )4NO ffNO <br /> Explanation:()SF. t IS41 SFi IIkt-Srv. u)l DP(t)U 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? n <br /> )(YES-Amount$ 43©,°_°- 0 New Connection, Alteration Repair, 0 Cap-off/Reconnect <br /> 0 N <br /> Explanation:LOh 1Y!ri Zi rS71/ h`oide-to CACI i/Se LXfj'cin A ov5e 45 0-ed/-/ or flew knife <br /> 4hd Chanya ,fir D6D ti. /O 47 hetihr 3475 dd• <br /> Existing Utility Permit#(if applicable): / <br /> SYSTEM DEVELOPMENT FEE? "- 74-7Z ex. hs` 4- Zit 3/ ADU <br /> �,( cd f 3¢7s--�" > 59ok <br /> )4 YES-Amount$ 4 5?O(€ Ai See Attached <br /> ❑ NO-No Change of Use/Other , ,,ii?-4) t7Pkt.t t-Ca 6,--t;7A, <br /> Explanation:' ,8 <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> YES-Amount$2/11OO 0 See Attached Spreadsheet <br /> ❑ NO <br /> A DRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> Ai YES-TYPE Sr72.-, See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: 9//5/or I <br /> /5 <br /> REVISED 10/11/2016 <br />