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EVERETT • I <br /> am PUBLIC WORKS REVIEW WORKSHEET <br /> mimi WASHINGTON <br /> PROJECT ADDRESS: 5406 S 1ST AVE Permit#: C1807-015 <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 SERVICF• (Attach Calculation&Cost Est) <br /> l 'New Connection to main plus I connections to building t57 New Connection, Size 3�yrt 0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size - u Per Cost Estimate <br /> ❑ Repair El Water System Development Fee Total:$ 3,'?5 <br /> ❑ Cap-off,quantity ®'Sewer System Development Fee Total: $ 5,12/.go <br /> ❑ Reconnection to stub 0 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#: LCCA Explanation/Utility Permit#: u( —0 05 <br /> IRRIGATION SERVI E: (Not Including Cost Estimates) FIRE SERVICE: ttach Cost Estimate/Request for Reference) <br /> ❑ New Connecti , Size 0 New Con tion, Size -0 Per Cost Estimate <br /> ❑ Meter Only ize 0%" De t Meter Only, Service Size <br /> ❑Water S tem Development Fee Total: $ 0 Bac ow Prevention (Outside Building): 0 DCDA <br /> ❑ Back Prevention (Outside Building): ❑ DCVA 'N REQUIRED <br /> 'NO REQUIRED Ex anation/Utility Permit#: <br /> Expl nation/Utility P mit#: <br /> WATER DEPA MENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qua y , See attached for reference. <br /> lit NOT QUIRED <br /> Plumbing P mits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑/Backflow evention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> E NOT R UIRED <br /> Building Permits (Note:Permit T nicians to add all items selected below to associated Building P mit) <br /> STORMWATER SYSTEM DEV MENT FEES: TRAFFIC MI GATION FEES: <br /> YES, Stormwater Total: 1 YES,T ffic Mitigation Total:$ 21/00•22. <br /> 0 Roof Only Fee Idg Permit(ground hard surf Aces fee on�PW Permit) ❑ ee Attached for calculations/credit <br /> lErAII Hard Su ce Fees to be added to Permit#liU 110g-Q`t b 0 T REQUIRED <br /> aSee Att ed Spreadsheet for calculations/credit <br /> ❑ NOT RE IRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> EYES-TYPE: 11SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> a See Attached Letter,2 copies(Permit Techs to issue one copy-to applicant with permits, scan one copy to Jeffrey Marks) <br /> EL Digital copy attached to permit record, Permit# pcomoir-0 6 <br /> ZSaved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> 0 YES-TypeNOT _ <br /> RD f <br /> hea onR FIKEE Qtt ----t i( ki 350 OF PH <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> 'DYES, Permit#PW 190E-O'I <br /> M'Stormwater NPDES Tab Completed in TRAKiT DADA Tab Completed in TRAKiT 14 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED aalt& <br /> ..____,0I <br /> Worksheet Completed By: vQ/j't/ /' Date: 12 10/11 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />