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EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> MEM WASHINGTON <br /> PROJECT ADDRESS: 6230 W BEECH ST Permit#: B2103-064 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADDITION OF 150SQ FT TO CREATE MASTER BATHROOM <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 0 Meter Only, Size - 0 Per Cost Estimate <br /> ❑ Repair 0 Water Sys m Development Fee Total: $ <br /> ❑ Cap-off, q entity 0 Sewer S tem Development Fee Total: $ <br /> ❑ Reconne ion to stub 0 Water ervice Line (behind meter), Size <br /> ❑ ackwa r Valve ❑ ac ow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> T QUIRED REQUIRED <br /> Explana on/Utility Permit#: Exp nation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: ttach Cost Estimate/Request for Reference) <br /> Cl New Connection, Size 0 New Conne on, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4"Detec eter Only, Service Size <br /> ❑ Water S stem Development Fee Total: $ 0 Backfl Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflo Prevention (Outside Building): 0 DCVA J GT EQUIRED <br /> OT EQUIRED Expl ation/Utility Permit#: <br /> Explan ion/Utili y Permit#: <br /> WATER DEP TMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Qua ity , See attached for reference. <br /> .. OT R UIRED <br /> Plum Ing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow revention (Inside Building): 0 DCVA(for Domestic service) ❑ RPBA (for Domestic service) 0 DCDA (for Fire service) <br /> p.NOT R UIRED <br /> ilding Permits (Note:Permit Technicians to add all ite :'selected below ssociated Buildin Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC TIGATION FEES: <br /> ES,p-See Attached for calculations/credit ❑YES, affic Mitigation Total: $ <br /> To be added on PW To be adde' on 2 It>3-06 4 0 ee Attached for calculations/credit <br /> Quantity charged SF Quantity arged /5v SF N REQUIRED <br /> QTY is 0 Ground only 0 all hard surfaces QTY is r 'oof onl ❑ all hard surfaces <br /> $ 3956 <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTE EQUIRED? (If yes (new assigned address), print out Addre Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See ttached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Di ital copy attached to permit record, Permit# <br /> ❑ aved to Address Folder in Development Tech File <br /> RIOT R UIRED <br /> FIRE SPRI LERS REQUIRED? <br /> ❑ YES— pe <br /> POT EQUIRED <br /> Reas <br /> PUBLIC WOR S PERMIT REQUIRED? <br /> ❑YES, Per it#PW <br /> tormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> NOT QUIRED <br /> Worksheet Completed By: Date: 0 4-124 /202-4 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />