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_ • <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 5222 EAST DR Permit#: PW2003-038 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR <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 0 connections to building 0 New Connection, Size - ❑ Per Cost Estimate <br /> ❑Alteration Meter Only, Size 1"e.wec>-0 Per Cost Estimate <br /> ❑ Repair 'Water System Development Fee Total:$ all.coo <br /> ❑ Cap-off, quantity Rt.Sewer System Development Fee Total: $ S2�o.00 <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or❑ DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Siz 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑%" Detect Meter Only, Service Size <br /> ❑Water System velopment Fee Total: $ 0 Backflow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow Pr ention (Outside Building): 0 DCVA SNOT REQUIRED <br /> RIOT REQ RED Explanation/Utility Permit#: <br /> Explanatio Utility Permit : <br /> WATER DEPARTME COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> KNOT REQU D <br /> Plumbing Per s (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Pre tion (Inside Building): ❑ DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> 0-NOT REQ ED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPM T FEES: TRAFFIC MITIGATIO FEES: <br /> EYES, Stormwater Total:$ c135 Z E_ .EYES,Traffic Miti tion Total: $24O ,cao <br /> 0 Roof Only Fee on Bldg Per, it(ground hard surfaces fee on PW Permit) 0 See Atta ed for calculations/credit <br /> 0AII Hard Surface Fees to •e added to Permit# ?.,.t 2so3-03.8 ❑ NOT REQ ED <br /> , See Attached Spread eet for calculations/credit <br /> ❑ 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 /> 0—YES—TYPE: JCSFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ISee Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> g Digital copy attached to permit record, Permit#'R,..2.bo3- 03 4�! <br /> Waved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS R UIRED? <br /> EYES—Type 3" <br /> ❑ NOT REQUIRP <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> DYES, Permit#PW o349 <br /> C Stormwater NPDES Tab Completed in TRAKiT A-ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By' Date: /o(/2/to ti.a <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />