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4err PUBLIC WORKS <br /> REVIEW WORKSHEET 11110 <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/3/2017 <br /> Permit#: PW1702-004 <br /> PROJECT ADDRESS: 1916 HOYT AVE <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR OVER NEW GARAGE <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: STEWARD JEFFREY B&CALLIE A NAME: MICHAEL GEORGE <br /> ADDRESS: 1914 HOYT AVE ADDRESS: <br /> EVERETT,WA, <br /> PHONE: PHONE: 4253305505 <br /> EMAIL: EMAIL: <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: CALLIE STEWARD <br /> PHONE: 2063809640 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?0 YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C /70/ —00I <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑YES—Amount$ 0 YES—Amount$ <br /> ❑ Meter Only, ❑ Complete Service, Size 0%"Detect Meter Only, ❑ Fire Service Size <br /> I.NO ❑ NO <br /> Explanation: Explanation: <br /> ❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> ❑Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> ❑YES—Amount$ 30 0 New Connection, Alteration/Repair, 0 Cap-off/Reconnect <br /> NO <br /> E❑xplaanation: kVA IA 44 it I U W1 10111 cI6k QTkrmil <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ,A YES—Amount$ 2-43 / El See Attached Spreadsheet Accessory/In-0 Aye LLi„o (.1 <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ a 0 See Attached Spreadsheet <br /> 1010 io- t--i ps Is CXes,p+ <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ..IV YES—TYPE S F .A`See Attached Letter <br /> ❑ NO <br /> 8, As <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />