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I • <br /> L.= EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> mom WASHINGTON <br /> PROJECT ADDRESS: 1 Ze, Roz,D1r DR. Permit#: e,i906-06 <br /> TENANT: M1A � si nop906_o O <br /> DESCRIPTION OF WORK: cS(Tt ()g C, Etre NU) SFz ( ' <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 /> Vra New Connection to main plus I connections to building ❑ New Connection,Size -0 Per Cost Estimate <br /> ❑Alteration ?rig Meter Only, Size J"oornIA l-0 Per Cost Estimate <br /> 0 Repair 0 Water System Development Fee Total:$ <br /> ❑Cap-off,quantity 0 Sewer System Development Fee Total:$ <br /> ❑ Reconnection to stub 1/iS Water Service Line(behind meter),Size 1" <br /> ❑ Backwater Valve 0 Backflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> ❑NOT REQUIRED 0 NOT REQUIRED CREDIT FOIEole METES ,4m(eb <br /> �/ <br /> Explanation/Utility Permit#: Li (q tf'DOcj Explanation/Utility Permit#:TO,[SYS DEVjjPeer. NET P 401 <br /> IRRIGATION SERVICE: (Not including Cost Estimates) FIRE SERVICE: (Attach Cost Estim to/Re uestfor Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> 0 Meter Only,Size 0 3/"Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ p,Backflow Prevention(Outside Building): ❑DCDA <br /> 0 Backflow Prevention(Outside Building): ❑DCVA �(NOT REQUIRED <br /> t NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> �/0 Yes, Quantity , See attached for reference. <br /> 1 KNOT 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 /> R NOT 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 /> Vol V YES, Stormwater Total:$ - OYES,Traffic Mitigation Total:$ O.—►J M <br /> tAm <br /> �0 Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> St Hard Surface Fees to be added to Permit# C1906-0/5 X NOT REQUIRED <br /> 0 See Attached Spreadsheet r calculations/credit / Nc ) S� 4 2400 <br /> ❑ NOT REQUIRED 1353 NAG - ,T S;� MOO <br /> tic <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: eL SFR 0 DUPLEX 0 ADU 01NFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ®See Attached Letter,2 copies(Permit Techs to issue one cop to applicant with permits,scan one copy to Jeffrey Marks) <br /> fa Digital copy attached to permit record, Permit# PWl906-05Yo <br /> g Saved to Address Folder in Development Tech File <br /> 0 NOT REQUIRED <br /> VIRE SPRINKLERS REQUIRED? <br /> ftYES-Type I D <br /> 0 NOT REQUIRED ,or <br /> Reason: FIRE CAGE, P£R. SN,O1 ( I 't ►Q�Qulgc rnFi,, TSr <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW 1906-050 <br /> l Stormwater NPDES Tab Completed in TRAKiT of ADA Tab Completed in TRAKiT Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED Worksheet Completed By: AEA- Q Date: 1 h2- Ur i <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />