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S <br /> - EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> mmie WASHINGTON <br /> PROJECT ADDRESS: 152 - F(,dg,Ip } pg. Permit#: 0,1906--0111 <br /> TENANT: NIA rW 06-0°I <br /> DESCRIPTION OF WORK: S 'OAK MC NEc1a SA . 0-or 2) <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 /> I14 New Connection to main plus I connections to building 0 New Connection,Size -0 Per Cost Estimate <br /> ❑Alteration Ifff Meter Only,Size)'corn1FlRE-0 Per Cost Estimate <br /> ❑Repair IS Water System Development Fee Total:$ 3,q$7'.°-v <br /> ❑Cap-off,quantity IR Sewer System Development Fee Total: $ 121.°s <br /> 0 Reconnection to stub $Water Service Line(behind meter),Size I" <br /> 0 Backwater Valve 0 Backflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: 11A,tr/ d" O l`� Explanation/Utility Permit#: Wit(-OD <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> 0 New Connection,Size 0 New Connection,Size -0 Per Cost Estimate <br /> ❑Meter Only,Size 0 3/4"Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 Backflow Prevention(Outside Building): ❑ DCDA <br /> 0 Backflow Prevention(Outside Building): 0 DCVA trili NOT REQUIRED <br /> via 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): ❑ DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> V III 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 /> sr if YES, Stormwater Total:$ 6 2-re YES,Traffic Mitigation Total:$ V100 <br /> 0 Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) ❑ See Attached for calculations/credit <br /> VI All Hard Surface Fees to be added to Permit# Q 1906-ON1 ❑ NOT REQUIRED <br /> 0 See Attached Spreadsheet for calculations/credit I� S1s12 NO CIQEDI T <br /> ❑ NOT REQUIRED 150 NN Ggp1o,oVt4 <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address),print out Address Letter from TRAKiT Print Menu and include) <br /> I 'YES—TYPE: M SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY ❑COMMERCIAL <br /> SI 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# PW1906-0L1q <br /> IS Saved to Address Folder in Development Tech File <br /> 0 NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> Si YES—Type 13 D <br /> 0 NOT REQUIRED <br /> Reason: Pik c�AQ6� P�•12. sI4o t RAT R eaw e6mEWS <br /> PM*BLIC WORKS PERMIT REQUIRED? <br /> YES,Permit#PW 1906-0419 <br /> Stormwater NPDES Tab Completed in TRAKiT Em'ADA Tab Completed in TRAKiT ffi Inspections Added in TRAKiT <br /> 0 NOT REQUIRED <br /> Worksheet Completed By: � Date: 9/Z/24l9 <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />