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4"7 • PUBLIC WORKS • <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/25/2017 <br /> Permit#: PW1707-043 <br /> PROJECT ADDRESS: 6009 FLEMING RD <br /> DESCRIPTION OF WORK: SITE WORK FOR 2-LOT SHORT PLAT <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POPACH VITALIY NAME: POPACH VITALIY <br /> ADDRESS: 6009 FLEMING ST ADDRESS: 6009 FLEMING ST <br /> EVERETT,WA,98203 EVERETT,WA, 98203 <br /> PHONE: 3602655904 PHONE: 3602655904 <br /> EMAIL: VAPELECTRIC@YAHOO.COM EMAIL: VAPELECTRIC@YAHOO.COM <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: JARRELL JESSE <br /> PHONE: 4253562700 <br /> EMAIL: JESSEJ@WESI.CO <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? ❑ YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br /> ❑YES—Type ( D (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: ,&a 2/ <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> tc <br /> DYES—Amount$ 3/ 6 t 6u 7, ❑YES—Amount$ <br /> 0 Meter Only, %Complete Service, Size IJ ❑3/4' Detect Meter Only, 0 Fire Service Size <br /> ❑ NO ❑ NO <br /> Explanation: Explanation: <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-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SE F E? <br /> $ 'New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Pu(tlic Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE_? <br /> ❑YES—Amount$ ❑ See Attached Spreadsheet <br /> ❑ NO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE -S d � 0 See Attached Letter <br /> ❑ NO VL� 6(PO1 <br /> PW Reviewer: � Date: <br /> 43:7 17 44 � ��j� S 6/2k J <br /> REVISED 10/11/2016 <br />