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EVE R E TT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 12902 19TH AVE SE #E Permit#: B1910-026 <br /> TENANT: DR JADE GAN <br /> DESCRIPTION OF WORK: TI FOR NEW DENTAL OFFICE <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 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> O Repair ❑Water System Development Fee Total: $ <br /> ❑ Cap-off,quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> 0140T REQUIRED LTIOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <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 3A" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA 121 L IOT REQUIRED <br /> KNOT 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 /> KNOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> BBackflow Prevention (Inside Building): 0 DCVA(for Domestic service) , RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> O 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 /> ❑YES, Stormwater Total: $ ®'.YES,Traffic Mitigation Total: $4'?2Z. ex) <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) El--See Attached for calculations/credit <br /> ❑All Hard Surface Fees to be added to Permit# 0 NOT REQUIRED £MAIL. FF••v► <br /> ❑ See Attached Spreadsheet for calculations/credit yA?s <br /> KNOT 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:. ❑ SFR 0 DUPLEX 0 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 /> Eir-NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> &NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> gL.NOT REQUIRED <br /> Worksheet Completed By: Date: I/It 9 2419 <br /> Worksheet Checked By: Date: it f19 1.1)11 <br /> REVISED 4/24/2019 <br />