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im EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 10225 1ST DR SE Permit#: C1908-008 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW SFR <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 ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration g&Meter Only, Size 3/4 " -0 Per Cost Estimate <br /> ❑ Repair *.Water System Development Fee Total:$ 3/SI. oo <br /> ❑ Cap-off, quantity I Sewer System Development Fee Total: $ .s red. o <br /> .-Reconnection to stub ❑Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 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 ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑W Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑.DCVA KNOT REQUIRED <br /> p-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 /> 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 /> AYES, Stormwater Total: $ 763.$ I NINES,Traffic Mitigation Total: $240o <br /> ❑Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> FLAII Hard Surface Fees to be added to Permit#"$‘,...1 I'tO8-o2V 0 NOT REQUIRED <br /> iil,See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> 0-YES—TYPE: SFR CI DUPLEX ❑ADU El INFILL DWELLING CI MULTI-FAMILY 0 COMMERCIAL <br /> I ee A tached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> A-Digital copy attached to permit record, Permit# "Pw i90 8- 02 co <br /> N Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> OT REQUIRED <br /> eason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> fliLYES, Permit#PW i90g -v2 Co <br /> g1Stormwater NPDES Tab Completed in TRAKiT I DA Tab Completed in TRAKiT 014nspections Added in TRAKiT <br /> Cl NOT REQUIRED <br /> Worksheet Completed By: Date: /f/48/2o e? <br /> Worksheet Checked By: Date: �x rsi`1•�� <br /> REVISED 4/24/2019 <br />