4328 FOREST DR 2022-02-08 - Laserfiche WebLink

PUBLIC WORKS REVIEW WORKSHEET (ATTACH 1 SITE PLAN FOR REVIEW) PROJECT ADDRESS: 4328 FOREST DR Date: 2/3/2017 Permit #: C1702-002 DESCRIPTION OF WORK: REBUILD MAIN FLOOR WALLS & ROOF/PARTIAL 2ND FLR ADDN CONTACT INFORMATION: OWNER: APPLICANT: NAME: LEE ROSE C REVOCABLE LIVING NAME: GILLILAND JEFF SE TRUST ADDRESS: ADDRESS: PO BOX 12165 if EVERETT, WA, 98206 PHONE: 4252389137 PHONE: EMAIL: EMAIL: CONTACT: ❑ Owner ❑ Applicant ❑Other NAME: [ContactName] PHONE: [ContactPhone] EMAIL: [ContactEmail] COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT M PW Permit Required? ❑ YES NO W.O. M Notes: N-m,- Associated Bldg./PW Permit #: FIRE SPRINKLER REQUIRED? (by Fire Department/Code) ❑ YES —Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) i'NO Explanation: (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) WATER FEES? DOMESTIC SERVICE: FIRE SERVICE. ❑ YES — Amount $ ❑ YES — Amount $ ❑ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size 'KNO XNO Explanation: Explanation: ❑ RPBA Needed at premise? -(Plumbing permit for backflow device needed due to High -Hazard Site per Tim Markham's review) ❑ Water Department Cost Estimate Needed -(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) Existing Utility Permit # (if applicable): SEWER FEE? ❑ YES — Amount $ JKNO Explanation: Existing Utility Permit # (if applicable): SYSTEM DEVELOPMENT FEE? ❑ YES —Amount $ NO — No Change of Use / Othe Explanation: ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect ❑ See Attached Spreadsheet (Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit (if applicable)) TRAFFIC MITIGATION FEE? ❑ YES — Amount $ ❑ See Attached Spreadsheet NO ADDRESS LETTER REQUIRED? ❑ YES — TYPE XNO (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) ❑ See Attached Letter PW Reviewer: REVISED 1011112016 Date: < ,11 q4lq_