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AIL <br />A101h <br />EVERETT W qw <br />WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br />PROJECT ADDRESS: 2002 OAKES AVE SE Permit#: PW2012-013 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: Paving for new garage <br />PWReviewerto select all that apply below: <br />Utility Permits (Note: Permit Technicians to Create Utility Pennit for Sewer, Water, Fire, and Irtigation, as selected below) <br />SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />11 New Connection to main plus connections to building 0 New Connection, Size - 13 Per Cost Estimate <br />13 Alteration E3 Meter Only, Size - 0 Per Cost Estimate <br />13 Repair EI Water System Development Fee Total: $ <br />' _' 'r <br />_0 <br />13 Cal' off, q ntity_ 0 Sewer S Ste Development Fee Total: $ <br />c <br />• Reconn tion to stub 0 Water Si� ice Line (behind meter), Size <br />vc <br />• Bac/kwer Valve 0 a ckKyo Frevention (Outside Building): 0 RPBA or 0 DCVA <br />OT <br />'�NOT EQUIRED VN QUIRED <br />Explan tion/ Utility Permit#: Explan ion/ Utility Permit #: <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate lRequest for Reference) <br />0 New Connection, Size 0 New ConnXtion, Size - 0 Per Cost Estimate <br />13 Meter Only, �ize 03 4' Dete Meter Only, Service Size <br />11 Water Sys 6eve pment Fee Total: $ [I Backfl Prevention (Outside Building): 0 DCDA <br />�O <br />te <br />Ty <br />1 <br />13 Backflow^event. n (Outside Building): 11 DCVA NrNO EQUIRED <br />'WNOT XQUIR Utility Permit#: <br />or <br />Explam on/ U i ity Permit #: <br />W r <br />ATERD ARTMENT COST ESTIMATE NEEDED-ff yes, PW Reviewer to send cost estimate request to Water Department) <br />0 Yes , antity See attached for reference. <br />NOT EQUIR0_ <br />Plulnbin ermits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />P,Back 10 � ention (Inside Building): 0 DCVA (for Domestic service) 0 RPBA (for Domestic service) 0 DCDA (for Fire service) <br />flo Prev <br />'v <br />VKNOT QUIRED <br />Building P its (Note: Pennit Technicians to add all item lected below to associated Building Permit) <br />rM. <br />' M <br />STORMWATE SYSTEM DEVELOPMENT FEES: TRAFFIC MJTIGATION FEES: <br />KYES, Storm ater Total:$ 15-t.-St El YES, 3/affic Mitigation Total: $ <br />11 Roof OnI Fee on Bldg Permit (ground hard surfaces fee on PW Pe it) EI Obe Attached for calculations credit <br />j <br />I&AIIHardS ace Fees to be added to Permit# ?W 0-0 I;t - 01 REQUIRED <br />t See Attache readsheet for calculations / credit <br />0 NOT REQUIRED <br />Additional Checklis <br />ADDRESS LETTER RE IRED? (if yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />E <br />Ch <br />TTE <br />e <br />R <br />C <br />R <br />k <br />E <br />" S <br />R <br />ED7 <br />13 YES — TYPE: 0 SF 03 DUPLEX 13 ADU E3 INFILL DWELLING 0 MULTI -FAMILY 0 COMMERCIAL <br />E F <br />tt d Letter' 2 <br />See Attac d Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />S eA a <br />y <br />0 D Figii t a I tc i c attached to permit record, Permit # <br />[J Save Address Folder in Development Tech File <br />D!�INOT REQUI <br />L S QUI 7 <br />FIRE SI L S tREQUIRED? <br />13 YES —Type,_ <br />YNOT RE(;tjjIRED <br />ea . , <br />son . , <br />PUBLIC WORKS PERMIT REQUIRED? <br />0 YES, Permit # PW <br />0 Stormwater NPDES Tab Completed in TRAKiT DADA Tab Completed in TRAKiT DInspections Added in TRAKiT <br />k<OT REQUIRED <br />Worksheet Completed By: Date: <br />Worksheet Checked By: Date: <br />REVISED 1112712019 <br />