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EVERETT <br />WASHINGTON <br />PROJECT ADDRESS: <br />TENANT: <br />DESCRIPTION OF WORK: <br />PUBLIC WORKS REVIEW WORKSHEET <br />1010 SE EVERETT MALL WAY STE 104 <br />EVERETT KIDNEY CENTER <br />Permit #: 131912-020 <br />TENANT IMPROVMENT AND NEW LOADING ZONE-EVERETT KIDNEY CRTR <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br />SANITARY SEWER: <br />❑ New Connection to main plus connections to building <br />❑ Alteration <br />❑ Repair <br />❑ Cap -off, quantity <br />❑ Reconnection to stub <br />❑ Backwater Valve <br />I( NOT REQUIRED <br />Explanation/ Utility Permit #: <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): ❑ DCVA <br />WNOT REQUIRED <br />Explanation/ Utility Permit #: <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size - ❑ Per Cost Estimate <br />❑ Water System Development Fee Total: $ <br />❑ Sewer System Development Fee Total`. $ <br />❑ Water Service Line (behind meter), Size <br />❑ Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />j( NOT REQUIRED <br />Explanation/ Utility Permit #: <br />FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ %" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building): ❑ DCDA <br />KNOT REQUIRED <br />Explanation/ Utility Permit #: <br />WATER DEPARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, Quantity See attached for reference. <br />KNOT 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) KRPBA (for Domestic service) ❑ DCDA (for Fire service) <br />❑ NOT REQUIRED An/ i iIJA / 1 Inn) (I 1 o A .�� � ��h I — A)-) in <br />Building Permits (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />YES, Stormwater Total: $ '7 <br />❑ Roof Only Fee on Bldg Permit (ground hard surfaces fee on PW Permit) <br />*All Hard Surface Fees to be added to Permit # TvJ110- - 031 <br />❑ See Attached Spreadsheet for calculations / credit <br />❑ NOT REQUIRED <br />Additional Checklists: <br />TRAFFIC MITIGATION FEES: <br />YES, Traffic Mitigation Total: $4!�S .06 <br />See Attached for calculations / credit <br />❑ NOT REQUIRED <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br />❑ YES —TYPE: ❑ SFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />❑ See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />❑ Digital copy attached to permit record, Permit # <br />❑ Saved to Address Folder in Development Tech File <br />I&NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type <br />Y4NOT REQUIRED <br />Reason: <br />P BLIC WORKS PERMIT REQUIRED? <br />YES, Permit # PW 031 <br />ftt-Stormwater NPDES Tab Completed in TRAKiT X ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: Date: <br />Worksheet Checked By: Date: Z f NOW <br />REVISED 1112712019 <br />