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PUBLIC WORKS <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) <br />PROJECT ADDRESS: <br />DESCRIPTION OF WORK: <br />10521 19TH AVE SE <br />Date: 3/13/2017 <br />Permit #: B1703-024 <br />PROVIDE SHELL AND CORE BLDG AND SITE DESIGN FOR UNFINISHED <br />CONTACT INFORMATION: <br />OWNER: <br />NAME: <br />SILVER PLAZA LLP <br />ADDRESS: <br />11419 19TH AVE SE <br />EVERETT, WA, 98208 <br />PHONE: <br />4252963523 <br />EMAIL: <br />RHEIDE.WBS@GMAIL.COM <br />APPLICANT: <br />NAME: <br />HEIDE RICHARD <br />ADDRESS: <br />11419 19TH AVE SE <br />EVERETT, WA, 98208 <br />PHONE: <br />2062278312 <br />EMAIL: <br />RHEIDE.WBS@GMAIL.COM <br />CONTACT: ❑ Owner ❑ Applicant ❑Other <br />NAME: JOHNSON, LARRY, JENSEN-FEY ARCHITECTURE <br />PHONE: 4252160318 <br />EMAIL: larryj@jensenfey.com <br />COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT #: <br />PW Permit Required? 19 YES ❑ NO W.O. #: <br />Notes <br />Associated Bldg./PW Permit #: go M13r0ZZI <br />FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br />YES -Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br />❑ NO <br />Explanation: <br />(Note: Counter Staff to Create Utility Permit for any Water/Sewer/Syste Development Fees) it <br />WATER FEES? mr <br />DOMESTIC SERVICE. FIRE SERVICE; L00 AZP 7 mli <br />)'YES - Amount $ Il )(YES - Amount $ �W ,� <br />❑ Meter Only, Complete Service, Sized �3/4" Detect Meter Only, ❑ Fire Service Size_ <br />13 NO 13 NO <br />Explanation: Explanation: 1,�� T Tpr I!wa 70 <br />❑ RPBA Needed at premise? -(Plumbing permit for backflow device needed due to High -Hazard Site per Tim Markham's review) <br />Water Department Cost Estimate Needed -(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br />Existing Utility Permit# (if applicable): 0 000—a r�rtA& lqr- 8 ""me ail ACMaha <br />SEWER FEE? <br />JK�YES -Amount $ )!(New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br />❑ NO (� <br />Explanation: bhA6) f yyihF�C:'EI�1'►, <br />Existing Utility Permit # (if applicable): <br />SYSTEM DEVELOPMENT FEES <br />YES - Amount $ 657 <br />❑ NO - No Change of Use / Other <br />Explanation: <br />9'See Attached Spreadsheet <br />(Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit (if applicable)) <br />TRAFFIC MITIGATION FEE? <br />)(YES - Amount $_ 76. ©: = )�See Attached Spreadsheet <br />❑ NO <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Add ess etter frpm TRAKiT Print M nu an include) <br />YES —TYPE (tnn'I�l 9fZCML ) 'See Attached Letter xot / 80 �1��,� ,`�G `�o p�(,(1 � <br />❑ NO \8i1,�. N� Sat * d�Yrc/ ln&r i <br />PW Reviewer: <br />KCV7J'CU 7U/77/LU7b <br />Date: <br />