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PUBLIC WORKS REVIEW WORKSHEET <br />PROJECT ADDRESS: 2002 MADISON AVE Permit #: 131809-002 <br />TENANT: VACANT <br />DESCRIPTION OF WORK: TI & LIGHT RENOVATION <br />PW Reviewer to select all that aoWy 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: (Not Including Cost Estimates) <br />❑ New Connection ❑ New Connection, Size <br />❑ Alteration ❑ Meter Only, Size <br />❑ Repair ❑ Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />❑ Cap -off 0140T REQUIRED <br />❑ Reconnect Explanation/ Utility Permit #: <br />R RIOT REQUIRED <br />Explanation/ Utility Permit #: <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Not Including Cost Estimates) <br />❑ New Connection, Size ❑ New Connection, Size <br />❑ Meter Only, Size ❑ %" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building): ❑ DCVA ❑ Backflow Prevention (Outside Building): ❑ DCDA <br />RIOT REQUIRED 'SOT REQUIRED <br />Explanation/ Utility Permit #: 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 />O'NOT REQUIRED <br />Plumbing Permits (Note: Permit Technicians to add all items selected below to Plumbing Permit) <br />❑ Water Service Line (behind meter), Size <br />❑ Backflow Prevention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />P NOT REQUIRED <br />Building Permits (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br />❑ YES, Water: $ ❑ YES, $ <br />Sewer: $ ❑ See Attached Spreadsheet for calculations/credit <br />❑ See Attached Spreadsheet for calculations/credit f!( NOT REQUIRED <br />NOT REQUIRED <br />Additional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br />❑ YES — TYPE <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 />piCNOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type <br />NrNOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />M-YES, Permit # PW 19 09- o IS <br />BStormwater NPDES Tab Completed in TRAKiT &ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />..Vol Worksheet Completed By: Date: 9 f ,O Al <br />.! 8 <br />Worksheet Checked By: Date: ! /2 �i / <br />REVISED 8/6/2018 <br />