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EVERETT PUBLIC WORKS REVIEW WORKSHEET <br />VW <br />WASHINGTON <br />PROJECT ADDRESS: 10225 1ST DR SE Permit #: B2010-025 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: CONVERT PORTION OF EXTG GARAGE TO LIVING/SLEEPING SPACE FOR <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 />NOT REQUIRED <br />Explanation/ 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 />t (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 />rOT REQUIRED <br />xplanation/ Utility Permit #: <br />FIRE SERVICE: (Attach Cost Estimate /Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ %" Detect Meter Only, Service Size <br />❑ l9ackflow Prevention (Outside Building): ❑ DCDA <br />'INOT REQUIRED <br />Explanation/ Utility Permit #: <br />WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br />❑jYes, Quantity , See attached for reference. <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: $ 53. 14 <br />❑ Roof Only Fee on Bldg Permit (ground hard surfaces fee on PW Permit) <br />;KAII Hard Surface Fees to be added to Permit # 0 &t I. <br />IXSee Attached Spreadsheet for calculations / credit <br />❑ NOT REQUIRED <br />Additional Checklists: <br />TRAFFIC MITIGATION FEES: <br />❑ YES, Traffic Mitigation Total: $ <br />❑ See Attached for calculations / credit <br />� OT REQUIRED <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br />❑ YES -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 />NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />FES -Type <br />OT REQUIRED <br />son: <br />PUBLIC WORKS PERMIT REQUIRED? <br />]kYES, Pymit # PW 2.0 1Z- 0 &t I <br />Stormwater NPDES Tab Completed in TRAKiT '4q ADA Tab Completed in TRAKiT ' Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />WorksheetCompletedBy: Ian Date: tZ 2j 20 <br />Worksheet Checked By: Date: <br />KCVlocu 77/L//LV7`J <br />