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• 4111 <br /> im EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 8417 EVERGREEN WAY Permit#: PW1805-015 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONST OF A NEW COMMERCIAL MULTI USE BUILDING <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 ERVICE: (Attach Calculation&Cost Est.) <br /> ❑ New Connection to m<'n plus connections to building 0 New Connectio ize -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, S', - -❑ Per Cost Estimate <br /> ❑ Repair • ❑Water Syst:` Development Fee Total:$ <br /> ❑ Cap-off,quan ' 0 Sewer S em Development Fee Total:$ <br /> Jeconnecti. to stub ❑Water ?ervice Line(behind meter),Size <br /> o Backwate- alve ❑ Bac 'ow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT R 41UIRED ®'N• REQUIRED <br /> rxplanation/Utility Permit#: <br /> E nation/Utility Permit#: �=rJ� T Z t� <br /> RIGATION SERVICE: (Not Incl ng Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/ equest for Reference <br /> 13Klew Connection, Size I" Clew Connection, Size•=4,11 -Cal Per Cost Estimate <br /> ❑ Meter Only, Size [ /a"Detect Meter Only, Service Size 43' <br /> LI'Water System Develo ent Fee Total:$ 14O , 0 Backflow Prevention(Outside Building): El DCDA <br /> Eft ackflow Preventio Outside Building): CVA El NOT REQUIRED <br /> ❑ NOT REQUIRE : planation/Utility Permit#: <br /> Explanation/Util' Permit#: <br /> ATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> axles, Quantity 4 , See attached for reference. .rt.c 5¢w ACC_ <br /> ❑ NOT REQUIRED <br /> Plumbing P its (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflo revention(Insid Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) A DCDA(for Fire service) <br /> G'a' JOT QUIRED <br /> Building Permits ote:Permit Technicians to add all items selected below to associated Building •ermit) <br /> STORMWATER SYSTE DEVELOPMENT FEES: TRAFFIC MIT ATION FEES: <br /> I4ES, Stormwater Tot;-l:$ 156,0I t 04 136ES,Traff Mitigation Total:$5034 S <br /> ❑ goof Only F-e o Bldg Permit(ground hard surfaces fee on PW Permit) ❑S-- .ttached for calculations/credit <br /> 0 All Hard Surfa'. 'Fees to be added to Permit# -f.16O -Oi 4- ❑ NOT RE N UIRED <br /> ❑See Attached Spreadsheet for calculations/credit ' earl/ <br /> O NOT REQUIRED - M <br /> Additional Checklis : AS c tQ� N 6 <br /> AD►RESS LETTER - • •UIRED? (If yes(new assigned address), print out Address Letter from TRANT Print Menu and include)ibiC - <br /> : ES-TYPE: I FR ❑ DUPLEX ❑ADU 0 INFILL DWELLING ❑ MULTI-FAMILY l 'COMMERCIAL .[ -I' <br /> I�Se; 'ttached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Mark l <br /> r ,gital copy attached to permit record, Permit# <br /> Saved to Address Folder in Development Tech File 4 t p <br /> o NO'REQUIRED J`3 ' <br /> FIRE SPRINKLER QUIRED? '4Ae.A cOX'€ <br /> [VYES-Type G'w►w 'rt 6 <br /> ❑ NOT RE <br /> Reason: i' <br /> PU LIC WORKS PERMIT REQUIRED? <br /> IDES, Pgrmit#PW ?W 15054,0V5- <br /> NI Stormwater NPDES Tab Completed in TRAKiT 151ADA Tab Completed in TRAKiT e Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: tb`—' ii Date: liZili 1 <br /> i <br /> Worksheet Checked By: - Date: �-12s12.01q <br /> REVISED 4/24/2019 <br />