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i <br />i <br />'"w 1%W <br />E VE R E T T PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 26 81ST ST SW Permit #: PW2001-010 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: MAIN FLOOR ADDITION 1100SF <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 o main plus connections to building ❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Alteration ❑ M/One - ❑ Per Cost Estimate <br />❑ Repair ❑ WDevelopmentFee Total: $ <br />❑ Cap -off, ntity ❑ SDevelopment Fee Total: $ <br />❑ Reconn tion to stub ❑ WLine (behind meter), Size <br />❑ Back ter Valve ❑ Bntion (Outside Building): ❑ RPBA or ❑ DCVA <br />eNO EQUIRED IKND <br />xplanation/ Utility Permit #: Explanation/ Utility Permit #: <br />IRRIGATIONS RVICE: (Not Including Cost Estimates) FIRE SERVICE: (ttach Cost Estimate / Request for Reference) <br />❑ New Conn tion, Size ❑ New Connec ' n, Size - ❑ Per Cost Estimate <br />❑ Meter Onl ,Size ❑ %" Detect eter Only, Service Size <br />❑ Wate/EQUIRED <br />tem Development Fee Total: $ ❑ Backflo revention (Outside Building): ❑ DCDA <br />❑ Backrevention (Outside Building): ❑ DCVA CMOT QUIRED <br />M(NOT Explan tion/ Utility Permit #: <br />Explanation/ Utility Permit #: <br />WATER DEPART NT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, Quantit See attached for reference. <br />I NOT RE RED <br />Plumbklig Permits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />❑ Backflow Pr ention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />A IOT REQ RED <br />Building Permits (Note: Permit Technicians to add all' ms cted below to associated Building Pe if) <br />STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITI TION FEES: <br />IYYES, Stormwater Total: $ ❑ YES, Tr is Mitigation Total: $ <br />gRoof Only Fee on Bldg Permit (ground hard surfaces fee on PW Permit) ❑ We Attached for calculations / credit <br />❑ All Hard Surface Fees to be added to Permit # �Gt� *�R7 0/-� 12� I:IN REQUIRED <br />11(See Attached Spreadsheet for calculations / credit <br />❑ NOT REQUIRED <br />Additional ChecrQUIRED? <br />ts: <br />ADDRESS LETTER (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />❑ YES /UI <br />FR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />hed Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />py attached to permit record, Permit # <br />Address Folder in Development Tech File <br />�VOT <br />FIRE SPRIN LERS REQUIRED? <br />❑ YES —T e <br />�rNOT QUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />I3kYES, Permit # PW ZOO I — O I O <br />Stormwater NPDES T Completed in TRAKiT ❑ ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By. Date: _�67 2'C2 <br />Worksheet Checked By: Date: 7,0 <br />Ht: M;LU 11/272019 <br />