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477. PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 6/13/2017 <br /> Permit#: C1706-009 <br /> PROJECT ADDRESS: 3511 UPLAND AVE <br /> DESCRIPTION OF WORK: NEW SFR-DETACHED P vv 707 -o44- <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: GORDON HOMES NAME: [AppName] <br /> ADDRESS: 9420 31ST AVE SE ADDRESS: [AppAdd] <br /> EVERETT,WA,98208 [AppCi], [AppSt], [AppZip] <br /> PHONE: 4253384596 PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: GORDON HOMES LLC <br /> PHONE: 4258761130 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?'YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C /7/9(p—LOO <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 /> XNO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? _ �6 O-7 o 03.6- <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 S/, ' <br /> a Size <br /> 'ANO 1,aLrei 11 ll �a;d �'o�^ f° ©k4 P¢r'fr;' reefs <br /> Explanation: r / Explanation: / roudrirenS <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? 00 <br /> ❑YES—Amount$ 79 T , New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> V SYSTEM DEVELOPMENT FEE? <br /> YES—Amount$ JDf 7 0 See Attached Spreadsheet 2/830 <br /> ❑ NO—No Change of t7se/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> t/ TRAFFIC MITIGATION FEE? d <br /> ❑YES—Amount$ Q� 0 See Attached Spreadsheet <br /> gNO raid sl)Ohfi ?cat <br /> ADDRESS LETTER RE UIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,1 YES—TYPE S.F - 0 See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> 7-27 17 <br /> REVISED 10/11/2016 <br />