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0 0 <br /> RE E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> MEN WASHINGTON <br /> PROJECT ADDRESS: 1713 BAILEY AVE Permit#: B2103-088 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADD ENCLOSED ENTRY TO EXTG SFR <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> ❑ New Connection to main plus connections to building 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnectio to stub 0 Water Se ice Line(behind meter),Size <br /> KBackwater alve CIBackflo Prevention(Outside Building): 0 RPBA or ElDCVA <br /> NOT REQ IRED r NOT QUIRED <br /> Explanatio Utility Permit#: Explana on/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 14,Backfl, w Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow revention (Outside Building): 0 DCVA NOT EQUIRED <br /> NOT R UIRED Explan tion/Utility Permit#: <br /> Explanati n/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 /> INOT REQU ED <br /> PlumbingPermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow P evention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> NOT RE IRED <br /> Building Permits (Note:Permit Technicians to add all items selected belo associated Building Permit <br /> STORMW TER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGA ON FEES: <br /> )(YES, See Attached for calculations/credit ❑YES,Traffic i itigation Total: $ <br /> To be added on PW To be added on 7 - On ❑ See A ached for calculations/credit <br /> Quantity charged SF Quantity charg 2.g$ SF KNOT R 0 UIRED <br /> QTY is❑ Ground only 0 all hard surfaces QTY is only 0 all hard surfaces <br /> $ $ 45 .s 3 <br /> ❑ NOT REQUIRED OVAdditional Checklists: <br /> ADDRESS LETT' R REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE. 0 SFR ❑ DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY ❑ COMMERCIAL <br /> ❑S;- Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ ►,igital copy attached to permit record, Permit# <br /> • Saved to Address Folder in Development Tech File <br /> KNOT - QUI ED <br /> FIRE `PRIN LERS REQUIRED? <br /> ❑YES—Ty e <br /> ANOT R QUIRED <br /> Reason: <br /> PUBLIC WOR S PERMIT REQUIRED? <br /> ❑YES, Perm' #PW <br /> O ormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> \NOT RE UIRED <br /> Worksheet Completed By: P's,Nk Date: 1fO tSI <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />