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0 411 <br /> E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 6103 ROCKEFELLER AVE Permit#: C1905-004 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW SFR DETACHED <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 ❑ Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity ❑Sewer System Development Fee Total: $ <br /> yr Reconnection to stub `� CA 0 Water Service Line(behind meter), Size <br /> El Backwater Valve ,reus � <br /> e— r C�i- 1V ' &L Sc - 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED .ma&c eA NOT 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 -❑ Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA NOT REQUIRED <br /> xl'NOT REQUIRED Explanation/Utility Permit#: <br /> planation/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 /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> ",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 /> ft(YES, Stormwater Total: $ a 77 ,vt ❑YES,Traffic Mitigation Total:$ <br /> Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) ❑ See Attached for calculations/credit <br /> All Hard Surface Fees to be added to Permit# ��/�IQ7 — O tA NOT REQUIRED <br /> See Attached Spreadsheet for calculations/credit <br /> D N T REQUIRED <br /> Additional Checklists: <br /> A DRESS LETTE REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES— PE: ' SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> See Attached Letter,2 copies (Permit Techs to issue o py to Applicant with permits, scan one copy to Jeffrey Marks) <br /> Digital copy attached to permit record, Permit#_PW( 0 t- 014! <br /> Saved to Address Folder in Development Tech File <br /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> ticNOT REQUIRED <br /> Reason: IA/ in .`3.50�O�' tft <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> 7 YES, Permit#PW / 9 09- — 0 2-Z_ <br /> Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT ,t1 Inspections Added in TRAKiT <br /> ❑ NOT RTQUIRED <br /> Worksheet Completed By: ,w-1 Date: -615.9/2 <br /> Worksheet Checked By: dialdt, 01 Date: 0 /5 <br /> REVISED 4/24/2019 <br />