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PUBLIC WORKS <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) <br />PROJECT ADDRESS: 4125 HOYT AVE UNITS A, B <br />DESCRIPTION OF WORK: NEW DUPLEX BLDG B <br />CONTACT INFORMATION: <br />OWNER: <br />NAME: MURPHY MANAGEMENT SERVICES <br />CORPORATION <br />ADDRESS: 7110 48TH AVE W <br />MUKILTEO, WA, <br />PHONE: <br />EMAIL: <br />CONTACT: ❑ Owner 91 Applicant ❑Other <br />NAME: ELAINE GROTH <br />PHONE: 4258764447 <br />EMAIL: ESG4DESIGN@GMAIL.COM <br />COMMENTS FROM PUBLIC WORKS REVIEWER: <br />PW Permit Required? P4 YES ❑ NO <br />Notes: <br />APPLICANT: <br />NAME: <br />ADDRESS: <br />Date: <br />Permit M <br />AW I,'I=":;16 if:l <br />12/29/2016 <br />C1612-011 <br />f f <br />PHONE: 4258764447 <br />EMAIL: ESG4DESIGN@GMAIL.COM <br />LAND USE PROJECT M <br />W.O. #: //n <br />Associated Bldg./PW Permit#: PW1W_0 3 <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 r- , <br />Explanation: OSA— �{Ys✓ kkff AA) A e�4JtA hF_ <br />(Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br />WATER FEES? <br />DOMESTIC SERVICE: FIRE SERVICE: <br />YES — Amount $ It ❑ YES — Amount $ <br />❑ Meter Only, Complete Service, Size / ❑ %" Detect Meter Only, ❑ Fire Service Size <br />❑ NO XNO <br />Explanation: Explanation: <br />140 RPBA Needed at premise? -(Plumbing permit for backflow device needed due to High -Hazard Site per Tim Markham review) <br />f'ep 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): <br />SEWER FEE? Q <br />❑ YES — Amount $ <br />19 NO <br />Explanation: s4aft <br />Existing Utility Permit # (if ap <br />❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br />SYSTEM DEVELOPMENT FEE? -tb j;LDG P6efitt7" FEES <br />P(YES — Amount $ ❑ See Attached Spreadsheet <br />❑ NO — No Change of Use / Other <br />Explanation: <br />(Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit (if applicable)) <br />TRAFFIC MITIGATION FEE? -A00 fill $LDG FIF9n'►rt- PVU <br />bt YES — Amount $ ©. ° ❑ See Attached Spreadsheet <br />❑ NO R W Du Ac4c, N0 4+eED11" <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />X YES — TYPE 1>1)ftj5' C A'See Attached Letter <br />❑ NO <br />PW Reviewer: <br />Date: 1301 go17 <br />