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• <br /> 0 E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4015 FRIDAY AVE Permit#: C1908-022 <br /> TENANT: [Ten Name] <br /> DESCRIPTION OF WORK: ADDITION OF 2 BEDROOMS TO EXISTING HOUSE <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 r-in plus connections to building 0 New Connection, Size - ❑ Per Cost Estimate <br /> ❑Alteration ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair 0 Water System D- elopment Fee Total:$ <br /> ❑ Cap-off,quan'y 0 Sewer Syste • Development Fee Total: $ <br /> ❑ Reconnect'. to stub 0 Water Se 'e Line(behind meter), Size <br /> ❑ Backwater alve ❑ Backflo 'revention (Outside Building): 0 RPBA or 0 DCVA <br /> tp,NOT REQUIRED NOT "QUIRED <br /> Explanati. /Utility Permit#: xplanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (A ach Cost Estimate/Request for Reference) <br /> ❑ New Connecion, Size 0 New Connecti , Size -0 Per Cost Estimate <br /> ❑ Meter Only Size 0 3 " Detect er Only, Service Size <br /> ❑Water S tem Development Fee Total:$ 0 Backflow revention (Outside Building): 0 DCDA <br /> ❑ Backfl Prevention (Outside Building): 0 DCVA NOT R UIRED <br /> 0xNOT EQUIRED Explanation/Utility Permit#: <br /> pla tion/Utilit Permit#: <br /> WATER DEP TMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qu tity , See attached for reference. <br /> 9,1NOT R QUIRED <br /> Plu ing Per its (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Pre ntion (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> OPNOT REQ ED <br /> Building Permits (Note:Permit echnicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVEL MENT FEES: TRAFFIC MITIGA N FEES: <br /> IN YES, Stormwater Total: $ 2 0 YES,Traffi itigation Total: $ <br /> a Roof Only Fee on Bldg ermit(ground hard surfaces fee on PW Permit) 0 See ttached for calculations/credit <br /> ist All Hard Surface Fee o be added to Permit# ?tom.?2.0¢72.—cc 1 NOT QUIRED <br /> 117 See Attached Spre sheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUI D? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: 0 SFR DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See Attache Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digital cop attached to permit record, Permit# <br /> ❑ Saved to ress Folder in Development Tech File <br /> 1 NOT REQUIRED <br /> FIRE SPRINKLE REQUIRED? <br /> ❑YES—Type <br /> qa NOT REQU ED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW Z®0 2 — pci <br /> q Stormwater NPDES Tab ompleted in TRAKiT RADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: e?Z / ° Ze .Z, <br /> Worksheet Checked By: .A* Date: <br /> REVISED 11/27/2019 <br />