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IL_IN E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 5625 EVERGREEN WAY Permit#: PW2011-028 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: MAKE PARKING LOT INTO CONCRETE, CUT OFF 20 FT OF CURB <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 -0 Per Cost Estimate <br /> ❑ Repair ❑Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity ❑ Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub ❑Water Service Line(behind meter),Size <br /> D,:ackwater Valve `❑ ckflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> ,NOT REQUIRED KNOT REQUIRED <br /> Explanation/Utility Permit#: xplanation/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 -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4' Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ ❑/:ackflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA z NOT REQUIRED <br /> KNOT 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 /> 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 /> IA 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 /> ❑YES, Stormwater Total:$ 0 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# � 'OT REQUIRED <br /> / ❑ See Attached Spreadsheet for calculations/credit <br /> \a 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 /> ❑YES-TYPE: ❑SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> ❑ Saved to Address Folder in Development Tech File <br /> �<NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> N❑ ES-Type <br /> OT REQUIRED <br /> eason: <br /> YP LIC WORKS PERMIT REQUIRED? <br /> ES, Per, it#PW 20 i1- 0 25c <br /> ►�/Stormwater NPDES Tab Completed in TRAKiT ,. DA Tab Completed in TRAKiT NYInspections Added in TRAKiT <br /> 0 NOT REQUIRED <br /> Worksheet Completed By: Date: ?,,f/IiV24 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />