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(ATTACH 1 SITE PLAN FOR REVIEW) <br />PROJECT ADDRESS: <br />DESCRIPTION OF WORK: <br />PUBLIC WORKS <br />REVIEW WORKSHEET <br />1412 KOSSUTH AVE <br />CONVERT GARAGE TO ADU <br />CONTACT INFORMATION: <br />OWNER: <br />NAME: ESCOBEDOINDALECIO <br />ADDRESS: 1410 KOSSUTH AVE <br />EVERETT, WA, <br />PHONE: <br />EMAIL: <br />CONTACT: ❑ Owner ❑ Applicant ❑Other <br />NAME: ESCOBEDOINDALECIO <br />PHONE: 4255014123 <br />EMAIL: indalecioescobedo@gmail.com <br />COMMENTS FROM PUBLIC WORKS REVIEWER: <br />PW Permit Required? YES ❑ NO <br />Notes: <br />Date: 2/22/ <br />Permit #: C1802-022 <br />APPLICANT: <br />NAME: ESCOBEDOINDALECIO <br />ADDRESS: 1410 KOSSUTH AVE <br />EVERETT, WA, <br />PHONE: <br />EMAIL: <br />LAND USE PROJECT <br />W.O. #: <br />Associated Bldg./PW Permit #: <br />FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br />❑ YES —Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br />$(NO <br />Explanation: <br />(Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br />WATER FEES? <br />DOMESTIC SERVICE: FIRE SERVICE. <br />❑ YES — Amount $ ❑ YES — Amount $ <br />❑ Meter Only, ❑ Complete Sp�e, ize ��� <br />❑ %" Detect Meter Only, ❑ Fire Service Size <br />NO °'�(NO <br />Explanation: " Explanation: <br />❑ RPBA Needed at premise? -(Plumbing permit for backflow device needed due to High -Hazard Site per Tim Markham's review) <br />❑ Water Department Cost Estimate Needed -(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br />Existing Utility Permit # (if applicable): <br />SEWER FEE? 'QQA <br />JWYES — Amount $ <br />❑ NO J2.� U 1� M" <br />Explanation: <br />Existing Utility Permit # (if applicable): <br />❑ New Connection, Alteratio epair, ❑ Cap-off/Reconnect <br />SYSTEM DEVELOPMEN FEE? <br />Ni YES — Amount $ ❑ See Attached <br />❑ NO — No Change of Use / Other Nb. <br />Al. &w w <br />Explanation: � � �— �,1��7ciY r t QI ely WvrCiv <br />(Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit (if applicable)) <br />TRAFFIC MITIGATION FEE? <br />❑ YES — Amount $ _ ❑ See Attached Spreadsheet <br />NO I'VO[ <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out,Addrgss Letter from TRAKiT Print Menu and include) <br />JX YES — TYPE U XSee Attached Letter�� i a kP-4k01W, `f' a#&r_ , d� perm <br />❑ NO `S 00�1 �T►ttit, C ss{�/ {e �� <br />PW Reviewer: <br />Date: <br />�/_ 1� <br />