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EVERETT <br />WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br />PROJECT ADDRESS: 10104 DAKOTA WAY Permit #: PW2011-037 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: SITE WORK FOR NEW SFR <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, qu tity <br />❑ Reconne ion to stub <br />Backw er Valve <br />NOT EQUIRED <br />xpla tion/ Utility Permit #: YU att aw ( to oW t-') <br />IRRIGATION SERVICE: (Not Including Cost Estimates) <br />❑ New Conne on, Size <br />❑ Meter Onl , Size <br />❑ Water S tem Development Fee Total: $ <br />❑ Backfl Prevention (Outside Building): ❑ DCVA <br />INOT EQUIRED <br />xpl ation/ Utility,Permit #: <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />)kNew Connection, Size 3 �r - ❑ Per Cost Estimate <br />❑ Meter Only, Size - ❑ Per Cost Es mate <br />AWater System Development Fee Total: $ ct 00 <br />❑ Sewer System Development Fee Total: $ <br />❑ Water Service Line (behind meter), Size <br />❑ Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />❑ NOT REQUIRED <br />Explanation/ Utility Permit #: <br />FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ %" Detect Met& Only, Service Size <br />❑ Backflow P vention (Outside Building): ❑ DCDA <br />Y <br />NOT R UIRED <br />plana 'on/ Utility Permit #: <br />WATER DEPA MENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, Quantyy , See attached for reference. <br />Plumbing ermits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />❑ Backflow revention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />*NOT RPQUIRED 1 <br />Building Permits (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />.YES, ❑ See Attached for calculations / credit <br />To be added on PW %rX i'0 l To be added on <br />Quantity charged 1 & V-3 SF Quantity charge <br />QTY is ❑ Ground only [ all hard surfaces QTY is ❑ Roof <br />$ (P6g-a® $ <br />❑ NOT REQUIRED <br />Additional Checklists: <br />lP YES, Traffic Mitigation Total: '40" 00 <br />❑ See Attached for calc tions / credit <br />SF ❑ NOT REQUIRED <br />❑ all hard surfaces <br />3�a0'4 <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br />1AYES -TYPE: P�,SFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />IdSee Attached Letter, 2 copies (Permit Techs to iss e one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />❑ Digital copy attached to permit record, Permit # 7iDii' 31 <br />❑ Saved to Address Folder in Development Tech File <br />❑ NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES -Type <br />KNOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />❑ YES, Permit # PW U a -© 3i <br />CStormwater NPDES Tab Completed in TRAKiT [�_ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: / Date: (! �! 2/1 <br />Worksheet Checked By: � /� yt� Q�1 (ilia leaws r_kk, Date: - i (Gj f 192-1% <br />KtV1Z5LU 77/Z//ZU78 <br />