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• • <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4018 GRAND AVE Permit#: C1905-001 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SFR ADDITION AND REMODEL <br /> P Reviewer to select all that apply below: <br /> tility Permits (Note:Permit Tech "ens to r..7 Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> 0 New Connection to main plus to building 0 New Connection, Size -❑ 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 ystem Development Fee Total: $ <br /> IS Reconnection to stub 0 Wat Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ B flow Prevention(Outside Building): ❑ RPBA or 0 DCVA <br /> ❑ NOT REQUIRED �F�j , n OT REQUIRED <br /> xplanation/Utility Permit#: `� planation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Con ection, Size -0 Per Cost Estimate <br /> ❑ Meter Only ize 0 3/4"Det t Meter Only, Service Size <br /> ❑Water S tem Development Fee Total: $ 0 Bac ow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backfl Prevention(Outside Building): ❑ DCVA N REQUIRED <br /> IX NOT EQUIRED Ex nation/Utility Permit#: <br /> Expla tion/Utility Permit#: <br /> WATER DE RTMENT COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Q ntity , See attached for reference. <br /> RIOT EQUIRED <br /> Plumbi Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Back w Prevention(Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> L `NO REQUIRED <br /> Building Permits (Note: rmit Technicians to add all items selected below to associated Building ermit) <br /> STORMWATER SYSTEM DE ELOPMENT FEES: TRAFFIC IGATION FEES: <br /> ieji YES, Stormwater Total:$ 22-OD ❑YES, affic Mitigation Total:$ <br /> Roof Only Fee on BI g Permit(ground hard surfaces fee on PW Permit) ee Attached for calculations/credit <br /> All Hard Surfac F s to be added to Permit# yet.) No 9, — Oo - I T REQUIRED <br /> ❑ See Attached Sp adsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Che klists: <br /> ADDRESS LETT RE a UIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: • SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> ❑ S-- Attached Letter, 2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> • l igital copy attached to permit record, Permit# <br /> ■ Saved to Address Folder in Development Tech File <br /> NO -EQUIRED <br /> FIRE SPRI LERS RE UIRED? <br /> ❑YES— pe <br /> NOT EQUIRED <br /> eas n: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW //ye --o <br /> Stormwater NPDES ab •ompleted in TRAKiT crADA Tab Completed in TRAKiT ylnspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Ade <br /> Worksheet Completed By: ^ A Date: 7 "6, <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />