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PUBLIC WORKS <br /> ciwy REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 5/23/2016 <br /> Permit#: PW1605-025 <br /> PROJECT ADDRESS: 3505 UPLAND AVE <br /> DESCRIPTION OF WORK: 3-Lot Short Plat <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: ACME HOMESLLC NAME: [AppName] <br /> ADDRESS: 10211 180th ST S.E. ADDRESS: [AppAdd] <br /> SNOHOHISH,WA, 98296 [AppCi], [AppSt], [AppZip] <br /> PHONE: 4259030292 PHONE: [AppPhone] <br /> EMAIL: acmepatrcia@gmail.com EMAIL: [AppEmail] <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PAT GOINS <br /> PHONE: 4259030292 <br /> EMAIL: acmepatricia@gmail.com <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?EYES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> 0 YES—Type t (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ExNO <br /> plaanation: rtydra a-- *VI 3561 — c! V <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$ rh ❑YES—Amount$ <br /> 0 Meter Only, '[Complete Service, Size ❑3/4" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO ZOO <br /> Explanation: xplanation: <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): UI 401--035 <br /> SEWER FEE? <br /> /itrYES—Amount$ )iZ(New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ENO <br /> xplanation: 1 d O <br /> Existing Utility Permit#(if applicable): VI� 'f o3S <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> NO—No Change of Use/Other <br /> Explanation: oil j( bs nsw sre c w�gay J''/, J,, <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to P Permit(if applicable)) /�/,1 /10.1-e2-..5;TRAFFIC MITIGATION FEE? 1 G1/ <br /> EYES—Amount$ l/g00 ❑ See Attached Spreadsheet V <br /> ' `1O n srk l f <br /> 2 �f+.c S�' rA rcll . s e,E, Qw1� 03--03166v)f.. ' <br /> uV <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Adess Letter from TRAKiT Print Menu and include) <br /> ❑YES—T •E 0 See Attached Letter <br /> I[NO � <br /> 7/0 /710./6 <br /> is Works Reviewer Si.•_ ure Da e <br /> REVISED 2/24/2016 <br />