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Aft Ask, <br />EVE R E T T <br />WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br />PROJECT ADDRESS: 5230 EAST DR Permit #: C2003-008 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: NEW SFR WITH ATTACHED GARAGE <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br />SANITARY SEWER: <br />Ffi!];New Connection to main plus <br />❑ Alteration <br />❑ Repair <br />❑ Cap -off, quantity <br />❑ Reconnection to stub <br />❑ Backwater Valve <br />❑ NOT REQUIRED <br />Explanation/ Utility Permit #: <br />connections to building <br />IRRIGATION SERVICE: (Not Including Cost Estimates) <br />❑ New Connection, Size <br />❑ Meter Only, Size <br />❑ Water System Development Fee Total: <br />❑ Backflow Prevention (Outside Building) <br />J�MOT REQUIRED <br />Explanation/ Utility Permit #: <br />❑ DCVA <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />(r Meter Only, Size 1 "65.44G- ❑ Per Cost Estimate <br />E% Water System Development Fee Total- '$ 4-1 <br />o"fZ.o 0 <br />[`Sewer System Development Fee Total: $ ,170 . oe <br />❑ Water Service Line (behind meter), Size <br />❑ Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />❑ NOT REQUIRED <br />Explanation/ Utility Permit #: <br />FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ 3/4" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building): ❑ DCDA <br />KNOT REQUIRED <br />Explanation/ Utility Permit #: <br />WATER DEPARTMENT COST ESTIMATE NEEDED-(/fyes, PW Reviewer to send cost estimate request to Water Department) <br />❑ 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 />❑ Backflow Prevention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />A 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 />WLYES, Stormwater Total: $ P 1 1. -1 3 MF YES, Traffic Mitigation Total: $ 2, 400. oo <br />❑ Roof Only Fee on Bldg Permit (ground hard surfaces fee on PW Permit) ❑ See Attached for calculations / credit <br />Rk All Hard Surface Fees to be added to Permit # ?r c v 4? ❑ NOT REQUIRED <br />IKSee 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 />DYES — TYPE: fe-SFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />UKSee Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />5VDigital copy attached to permit record, Permit # 'PwZo10 - C 4'7 <br />Saved to Address Folder in Development Tech File <br />❑ NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />5KYES —Type t <br />❑ NOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />6ES, Permit # PW - /AEG - o 4'/ <br />CJ�Stormwater NPDES Tab Completed in TRAKiT E^ ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: L_ Date: <br />Worksheet Checked By: Date: <br />REVISED 1112712019 <br />