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EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> Nom WASHINGTON <br /> PROJECT ADDRESS: 1502 SE EVERETT MALL WAY Permit#: PW1907-039 <br /> TENANT: VACANT-TBD <br /> DESCRIPTION OF WORK: REROUTE 2 WTR SVC LINES AND REPLACE CONC SLAB WITH ASPHALT <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: (Attach Calculation &Cost Est.) <br /> ❑ New Connection to main plus connections to building ❑ New Connection, Size -❑ Per Cost Estimate <br /> ❑Alteration ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $ <br /> ❑Cap-off, quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub x %"Water Service Line(behind meter), Size I ',,p 2" <br /> ❑ Backwater Valve • Backflow Prevention (Outside Building): ❑ RPBA or 0 DCVA <br /> OT REQUIRED 0 NOT REQUIRED REao..-rt cam_ SC.Am, � <br /> xplanation/Utility Permit* Explanation!Utility Permit#: S. sca.. = .Arr--rUa.S <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 3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA 9Z1 NOT 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 /> NOT 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 /> WNOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> BYES, Stormwater Total:$ 24 8.4 4 ❑YES,Traffic Mitigation Total:$ <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> vAll Hard Surface Fees to be added to Permit#'TVN lei -03 9 KNOT REQUIRED <br /> ❑ See Attached Spreadsheet for calculations!credit <br /> ❑ 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: 0 SFR 0 DUPLEX ❑ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <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 /> ❑ Saved to Address Folder in Development Tech File <br /> KNOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> ;NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> DYES, Permit#PW 19 O 7. 03 9 <br /> tit.Stormwater NPDES Tab Completed in TRAKiT p.ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: 7/25 2_.O t 9 <br /> Worksheet Checked By: ChlAk Date: "4-IRS W11 <br /> REVISED 4/24/2019 <br />