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• • <br /> L EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> immi WASHINGTON <br /> PROJECT ADDRESS: 3527 SHORE AVE Permit#: B2005-040 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: INTERIOR REMODEL KITCHEN/MASTER BEDROOM AND BATH/AND(2) <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 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration ❑ Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑Cap-off,quan' 0 Sewer System Development Fee Total:$ <br /> ❑ Reconnectio to stub 0 Water Se ice Line(behind meter), Size <br /> ❑ Backwater alve 0 Backflo revention (Outside Building): 0 RPBA or❑ DCVA <br /> OT RE UIRED SOT QUIRED <br /> xplanati /Utility Permit#: Expla ion/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> O New Connection, Size ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑Meter Only, ize 0 3/4"Det t Meter Only, Service Size <br /> ❑Water Sys m Development Fee Total: $ ❑ Bac ow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflo revention (Outside Building): 0 DCVA REQUIRED <br /> . NOT QUIRED -.Exp nation/Utility Permit#: <br /> Explan on/Utility Permit#: <br /> WATER DEP TMENT COST ESTIMATE NEEDED-(/f yes, PWReviewerto send cost estimate request to Water Department) <br /> ❑Yes, Qu tity , See attached for reference. <br /> ,gt-NOT R QUIRED <br /> Plu ing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> RIOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIG ON FEES: <br /> )3I-YES, Stormwater Total: $ 14, 70 ❑YES,Traffic itigation Total: $ <br /> -Roof Only Fee on Bldg Permit(ground hard surfris o Per EA El See ached for calculations/credit <br /> ❑All Hard Surface Fees to be added to Permit# '- v—� '-PLOT QUIRED <br /> ❑See 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 /> ❑YES-TYPE: 0 SFR 0 DUPLEX 0 ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ D. ital copy attached to permit record, Permit# <br /> ❑ aved to Address Folder in Development Tech File <br /> fersIOT QUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-T e _ <br /> NOT QUIRED <br /> Reason . <br /> PUBLIC WORKS ERMIT REQUIRED? <br /> ❑YES, Permit W <br /> ❑ S mwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ,Ii-PIOT RE IRED <br /> Worksheet Completed By. r Date: e,7It6 / <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />