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E E R E T T <br />WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br />PROJECT ADDRESS: 1803 112TH ST SE Permit #: PW2002-033 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: INSTALL (2) CATCH BASINS/ REPAVE AND REPLACE CURB TO PREVENT <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 ❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Alteration ❑ Meter Only, Size - ❑ Per Cost Estimate <br />❑ Repair ❑ Water System Development Fee Total: $ <br />❑ Cap -off, quantity ❑ Sewer System Development Fee Total: $ <br />❑ Reconnection to stub ❑ Water Service Line (behind meter), Size <br />❑ Backwater Valve ❑ Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />VNOT REQUIRED NOT REQUIRED <br />Xplanation/ Utility Permit #: Explanation/ Utility Permit* <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate /Request for Reference) <br />❑ New Connection, Size ❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size ❑ %" Detect Meter Only, Service Size <br />❑ Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): ❑ DCDA <br />❑ Backflow Prevention (Outside Building): ❑ DCVA PKNOT REQUIRED <br />$LNOT REQUIRED Explanation/ Utility Permit #: <br />Explanation/ Utility Permit #: <br />WATER DEPARTMENT COST ESTIMATE NEEDED-(Ifyes, 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 />FLNOT 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 />YES, Stormwater Total: $ /OD • A2 ❑ YES, Traffic Mitigation Total: $ <br />Roof Only Fee on Bldg Permit (ground hard surfaces fee on PW Permit) ❑ See Attached for calculations / credit <br />All Hard Surface Fees to be added to Permit # "RwLo&2.- c 33 ANOT REQUIRED <br />See Attached Spreadsheet for calculations / credit <br />❑ NOT REQUIRED <br />Additional Checklists: <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 />&NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type <br />JkNOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />YES, Permit # PW 20OZ- O" <br />,4Stormwater NPDES Tab Completed in TRAKiT PKADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: � Date: O2 202-0 <br />Worksheet Checked By: Date: 5 7,0Zo <br />REVISED 1112712019 <br />