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PUBLIC WORKS <br /> — .,„ REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 1/29/2018 <br /> Permit#: PW1801-053 <br /> PROJECT ADDRESS: 4730 COLBY AVE <br /> DESCRIPTION OF WORK: SITE DEVELOPMENT FOR NEW YMCA FACILITY <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: YOUNG MENS CHRISTIAN NAME: JUSTIN GOROCH, PE BCRA <br /> ASSOCIATION ADDRESS: 414 STEWART ST SUITE#200 <br /> ADDRESS: 2720 ROCKEFELLER AVE SEATTLE,WA,98101 <br /> EVERETT,WA,98201 PHONE: 2536274367 <br /> PHONE: EMAIL: jgoroch@bcradesign.com <br /> EMAIL: <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: JUSTIN GOROCH, PE BCRA <br /> PHONE: 2536274367 <br /> EMAIL: jgoroch@bcradesign.com <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?'YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: 8/$O5-0/$ <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> EYES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: <br /> (Note: Counter Staff to CreateU tility Permit for any V1 Water/Sewer/System Development Fees) B K� w P 1/�11�� ,, <br /> WATER FEES? RIGtRnoN 3MV'ICE: ►. � DC <br /> f1E1 0Nu f VA <br /> DOMESTIC SERVICE: (A-I gL g-D01 5,121RE SERVICE: tk1$o r-o Z <br /> CI YES—Amount$ ill *YES—Amount$ 500. /, <br /> 0 Meter Only, CI 'Complete Service, Size " Detect Meter Only, ❑ Fire Service Size 6 <br /> ❑ NO w� i ❑ NO <br /> Explanation: EA for y" mE1*F.r/St'YIeFi Explanation: <br /> RPBA Needed atpremise?-(Plumbing permit for back�kflow device needed due to High-Hazard Site per Tim Markham's review)Pf 8Ot'rJ62. <br /> 'Water Department Cost Estimate Needed-(If yes, PWt Revie Reviewer tor o send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): 14 see /me/1eb (7.) KEQVesTEI) F^.577/7 ,s —OK¢oissu P m+ ahaul <br /> SEWER FEE? arts:Sfesk v t�• <br /> %YES—Amount$ • )(New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO go-7—volt <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> „,/SYSTEM DEVELOPMENT FEE? v� ssuvr <br /> EYES-Amount$ 144; 53.95 JR[See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> Vote:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> RAFFIC MITIGATION FEE? <br /> RYES—Amount$ I CNI y00. �' )(See Attached Spreadsheet <br /> El -t J NO i. Foie ENnee t s q' BuK-0-eur —PEA 6165M RAMe, ( NSti� s REPtnZf D / 6v '' i <br /> pADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address L tter from T Ki Prr'nt Menu and includ ) <br /> fib EES—TYPE ezmin&i2 4A2._ _ J See Attached Letterx2,enE is Q XI q�£d 'Fo Pal Po NO <br /> €,tml <br /> CAA oitteir JJ-b J e--Frj P arks <br /> PW Reviewer: ,irt: frtiac <br /> ......kgai 2C Date: 0011zetig <br /> REVISED 10/11/2016 <br />