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14477. • PUBLIC WORKS <br /> REVIEW WORKSHEET • <br /> d/ - 01 <br /> 4 <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/24/2016 <br /> Permit#: PW1602-048 <br /> PROJECT ADDRESS: 5TH AVE W (Town il E # l of f 3") <br /> DESCRIPTION OF WORK: PW SITE FOR NEW 13 UNIT TOWNHOMES <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: KULAGA AHMET&SEVALA NAME: KULAGA AHMET&SEVALA <br /> ADDRESS: 1205 130TH ST SE UNIT A ADDRESS: 1205 130TH ST SE UNIT A <br /> EVERETT,WA, 98208 EVERETT, WA, 98208 <br /> PHONE: 4255016441 PHONE: 4255016441 <br /> EMAIL: KULAGA_A@HOTMAIL.COM EMAIL: KULAGA_A@HOTMAIL.COM <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: WELAYE MAHER <br /> PHONE: 2068160455 <br /> EMAIL: maherwelaye@gmail.com <br /> COMMENTS FROM PUBLIC/ORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?t YES 0 NO W.O. #: <br /> Notes: Associated Bldg./PW Permit#: C j�Q(xp <br /> SIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br /> )31 YES—Type (5 D (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: FII?C CIF <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: /gL FIRE SERVICE: <br /> slg YES—Amount$ SW: ❑ YES—Amount$ <br /> 'El Meter Only, 0 Complete Service, Size I�i 0 '/4" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO NO <br /> Explanation: SER. g,0 amemm&rr.T Explanation: <br /> N jpn RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> IR❑Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit# (if applicable): <br /> SEWER FEE? <br /> IN YES—Amount$ -910:29" llgfNew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: SU— ATMOttD Sf2€SHOT" <br /> Existing Utility Permit# (if applicable): <br /> L SYSTEM DEVELOPMENT FEE? q ' <br /> ' YES—Amount$ 0¢ _ 0 See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> / <br /> Explanation: k 1 /c3wil E (SE.£. /}C''/tift NRBADd7/Cer) <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> psLYES—Amount$ 1g©0,eo <br /> ❑ See Attached Spreadsheet <br /> ❑ NO Lj 6 hI SF,ppy2> , Pl v P funoz,' <br /> ADDRESS LETTER REQ IRED? (If yes (neyv assigned address), print out Address Letter fro TR KiT Pr'nt e u and include) <br /> PR/YES—TYPE T ru.r l'e- nti See Attached Letter f �tc J ' U ./A, /' <br /> ❑ NO ufrde 14-(E , U )644, 1 J fiZV 4 <br /> PW Reviewer: C�( Date: / <br /> REVISED 10/11/2016 <br />