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in 410 0 <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 607 SE EVERETT MALL WAY Permit#: B2008-029 <br /> TENANT: FORMER 7-11 <br /> DESCRIPTION OF WORK: CREATE RETAIL SPACES IN THE FORMER CONVENIENCE STORE <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, antity 0 Sewer Sys m Development Fee Total:$ <br /> ❑ Reconn ion to stub 0 Water S ice Line(behind meter),Size <br /> ❑ Backw ter Valve Backfl Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> 14 NOT EQUIRED NOT EQUIRED <br /> Expla tion/Utility Permit#: Explan tion/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%" Det t Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Back w Prevention (Outside Building): 0 DCDA <br /> ❑ Backflo Prevention(Outside Building): 0 DCVA 1/NO REQUIRED <br /> igl NOT QUIRED Expla ation/Utility Permit#: <br /> Explan on/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qu tity See attached for reference. <br /> 6,NOT QUIRED <br /> Plum in Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflo Prevention(Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> 121 NOT QUIRED <br /> —.y <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIUATION FEES: <br /> ❑YES, Stormw ter Total:$ 0 YES,Tra c Mitigation Total:$ <br /> ❑ Roof O Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 Se Attached for calculations/credit <br /> ❑All Har Surface Fees to be added to Permit# II NOT QUIRED <br /> ❑See ached Spreadsheet for calculations/credit <br /> P NOT RE UIRED <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 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑See A ached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digit copy attached to permit record, Permit# <br /> ❑Sa d to Address Folder in Development Tech File <br /> 12(NOT REQ I ED <br /> FIRE SPRIN LERS REQUIRED? <br /> ❑YES—Tye <br /> NOT R UIRED <br /> e`-son: <br /> / PUBLIC WORKS PERMIT REQUIRED? <br /> Tit YES, Permit#PW so‘0 --0?A <br /> 37:j Stormwater NPDES Tab Completed in TRAKiT 'ADA Tab Completed in TRAKiT 110 Inspections Added in TRAKiT <br /> 0 NOT REQUIRED <br /> Worksheet Completed By: Ati Date: (o/°C(2 0 <br /> %A rLehcc+(`hcnLcrl Rv <br /> Il.,tc• <br /> REVISED 11/27/2019 —" `" <br />