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L EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 7621 BEVERLY LN Permit#: B2004-011 <br /> TENANT: EVERGREEN MIDDLE SCHOOL <br /> DESCRIPTION OF WORK: RELOCATION OF(1)28'X32'PORTABLE CLASSROOM <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 /> 0 Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> 0 Repair 0 Water System Development Fee Total: $ <br /> 0 Cap-off,quantity_ 0 Sewer System Development Fee Total: $ <br /> 0 Reconnection to stub ❑Water Service Line(behind meter), Size <br /> 0 Backwater Valve 0 Backflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> y(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 /> 0 New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> 0 Meter Only, Size CI " Detect Meter Only, Service Size <br /> 0 Water System Development Fee Total: $ 0 Backflow Prevention(Outside Building): 0 DCDA <br /> 0 Backflow Prevention(Outside Building): 0 DCVA j8(NOT REQUIRED <br /> NOT 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 /> 0 Yes, Quantity , See attached for reference. <br /> )�NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> o Backflow Prevention(Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> E 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 /> EYES, Stormwater Total: $261.02 EYES, Traffic Mitigation Total: $54199.0/ <br /> 0 Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> MAll Hard Surface Fees to be added to Permit# 710004-026 0 NOT REQUIRED <br /> 0 See Attached Spreadsheet 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: ❑SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> 0 See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> 0 Digital copy attached to permit record, Permit# <br /> 0 Saved to Address Folder in Development Tech File <br /> )8(NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> 0 YES—Type <br /> E NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> E YES, Permit#PW 2004-026 <br /> Stormwater NPDES Tab Completed in TRAKiT EADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> 0 NOT REQUIRED <br /> Worksheet Completed By: ? 10"e Date: 04/ 2/2a2D <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />