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PUBLIC WORKS REVIEW WORKSHEET <br />PROJECT ADDRESS: <br />TENANT: <br />DESCRIPTION OF WORK: <br />14 E CASINO RD <br />Permit #: B1903-001 <br />[TenName] <br />TENANT IMPROV OF EXTG OFFICE BLDG-CASINO RD INITIATIVE <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, quantity <br />❑ Reconnection to stub <br />❑ Backwater Valve <br />fxNOT REQUIRED <br />anation/ Utility Permit #: <br />IRRIGATION SERVICE: (Not Including Cost Estimates) <br />❑ New Connection, Size <br />❑ Meter Only, Size <br />❑ Water System Development Fee Total: $ <br />❑ Backflow Prevention (Outside Building): ❑ DCVA <br />X-NOT REQUIRED <br />'Explanation/ Utility Permit #: <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size - ❑ Per Cost Estimate <br />❑ Water System Development Fee Total: $ <br />❑ Sewer System Development Fee Total $ <br />❑ Water Service Line (behind meter), Size <br />❑ Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />OT REQUIRED <br />Explanation/ Utility Permit #: <br />FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ 3/" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building): ❑ DCDA <br />PKNOT REQUIRED <br />Explanation/ Utility Permit #: <br />WATER DEPARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, Quantity See attached for reference. <br />KNOT 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 />NOT REQUIRED <br />Building Permits (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />YES, Stormwater Total: $ J t ` - 3 $ <br />I(See Attached Spreadsheet for calculations <br />❑ NOT REQUIRED <br />Additional Checklists: <br />TRAFFIC MITIGATION FEES: <br />❑ YES, Traffic Mitigation Total: $ <br />❑ See Attached Spreadsheet for calculations/credit <br />,ANOT REQUIRED <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br />OYES —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 />fit <br />NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type <br />YNNOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />YES, Per it # PW / 0 4 - d o -b <br />Stormwater NPDES Tab Completed in TRAKiT �,ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: Date: 4 <br />Worksheet Checked By: Date: Slull. <br />Kt VIJtU Z/ZZ/ZU78 <br />