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PUBLIC WORKS <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) <br />PROJECT ADDRESS: 1909 MONROE AVE <br />DESCRIPTION OF WORK: NEW DADU W/ATTACHED GARAGE <br />CONTACT INFORMATION: <br />OWNER: <br />NAME: GARZA RUDOLFO R <br />ADDRESS: 1909 MONROE AVE <br />EVERETT, WA, 98203-5326 <br />PHONE: <br />EMAIL: <br />CONTACT: ❑ Owner ❑ Applicant ❑Other <br />NAME: [ContactName] <br />PHONE: [ContactPhone] <br />EMAIL: [ContactEmail] <br />COMMENTS FROM PUBLIC WORKS REVIEWER: <br />PW Permit Required? ❑ YES ❑ NO <br />Notes: <br />Date: 10/6/2017 <br />Permit #: C1710-002 <br />APPLICANT: <br />NAME: [AppName] <br />ADDRESS: [AppAdd] <br />[AppCi], [APpSt], [APpZip] <br />PHONE: [AppPhone] <br />EMAIL: [AppEmail] <br />LAND USE PROJECT #: <br />W.O. #: <br />Associated Bldg./PW Permit#: 1pw/P0 "dui <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 />1planation: <br />NO <br />(Note: Counter Staff to Create Utility Permit for any Water/SewedSystem Development Fees) <br />WATER FEES? <br />DOMESTIC SERVICE: FIRE SERVICE: <br />❑ YES —Amount $ ❑ YES — Amount $ <br />❑ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size <br />WNO <br />"ENO <br />planation: 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? <br />❑ YES — Amount $ ❑ New Connection, gAlteration/Repair, ❑ Cap-off/Reconnect <br />❑ NO <br />Explanation: <br />Existing Utility Permit # (if applicable): <br />SYSTEM DEVELOPMENT FEE? <br />YES — Amount $ -Z 144a / <br />❑ NO — No Change of Use / Other <br />Explanation: <br />❑ See Attached Spreadsheet X16 u 4ed�' <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 />1P NO <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br />❑ YES — TYPE ❑ See Attached Letter <br />y NO <br />PW Reviewer: Date: t' / t V W j ?i <br />-»nca� z��marrr, <br />