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OM 0 <br /> - EVE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 10817 HOLLY DR Permit#: BW1912-003 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADULT FAMILY HOME INSPECTION, CONSTRUCT RAMP <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 -❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair 0 Water Syste Development Fee Total:$ <br /> ❑ Cap-off,quaDtity 0 Sewer Sy m Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water S ice Line(behind meter), Size <br /> ❑ Backwate alve ElBackfl Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> )NOT RE UIRED 17NOT EQUIRED <br /> xplanatio /Utility Permit#: xplanation/Utility Permit#: , <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, ize 0 3/" Dete t Meter Only, Service Size <br /> ❑Water Sys m Development Fee Total: $ ❑ Backfl Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow revention (Outside Building): 0 DCVA 9dClOT EQUIRED <br /> MOT RE UIRED Explanation/Utility Permit#: <br /> Explanatio /Utility Permit#: <br /> WATER DEPART ENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> I NOT REQU ED <br /> Plumbing Per its (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prey ntion (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> �fNOT REQUI D <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC M IGATION FEES: <br /> RYES, Stormwater Total: $ `Z Z 3 ,G' 0 YES,Tr ffic Mitigation Total:$ <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 S Attached for calculations/credit <br /> Ig All Hard Surface Fees to be added to Permit# JNOT EQUIRED <br /> BF See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: 0 SFR ❑ DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> ❑ S e Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ gital copy attached to permit record, Permit# <br /> ❑ aved to Address Folder in Development Tech File <br /> 4INOT R QUIRED <br /> FIRE SPRINK RS REQUIRED? <br /> ❑YES—Typ <br /> BOOT RE UIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? e4 <br /> cif YES, Permit#PW'Al ;Zoo? ---td0 <br /> a Stormwater NPDES Ta Completed in TRAKiT $1 ADA Tab Completed in TRAKiT Er Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: 0 2 2-90:72/0 <br /> Worksheet Checked By: Date: S <br /> t /5 UV <br /> REVISED 11/27/2019 <br />