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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 2217 MADISON ST Permit#: CW1907-001 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CHANGE SFR BASEMENT INTO DUPLEX UNIT,ADD DECK UPPER UNIT <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 KNew Connection, Size S1k% -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair *Water System Development Fee Total:$ 4,0 vi. <br /> o Cap-off,quantity Sewer System Development Fee Total:$ 5i2.1•0 <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> CI Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> NOT REQUIRED ❑ NOT REQUIRED plfr,W <br /> _ •lanation/Utility Permit#: Explanation/Utility Permit#: :2- 1- Mhb1S00 ST/ ut.)IT % <br /> UAJ1t A 1D Rouse ex---..... <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0%" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ p Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA OT REQUIRED <br /> NOT REQUIRED Explanation/Utility Permit#: <br /> xplanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> )(NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prevention(Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> V KNOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) c.W tip-fro-at <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> 47 AYES, Stormwater Total: $ 30 i 20 , ttpo 't0 CM lA0}-00% YES,Traffic Mitigation Total:$ 714 d 0 <br /> Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> ❑All Hard Surface Fees to be added to Permit# 0 NOT REQUIRED <br /> )itSee Attached Spreadsheet for calculations/credit N EW b1APLE% • u.$0 <br /> o NOT REQUIRED — GtkE DV(' EXtSTIOGI CFK= 2-1b0 <br /> Additional Checklists: NEC far, q 2't04 <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> AYES—TYPE: 0 SFR DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> Digital copy attached to permit record, Permit# ?IP) 2.010 —0 t' <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT EQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> )irkNOT REQUIRED 11 <br /> Reason: Qj1410 10 r 0f f-A <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> )(YES, Permit#PW t.0k0 — 0 A <br /> .Stormwater NPDES Tab Completed in TRAKiT RADA Tab Completed in TRAKiT Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: I�Nk Date: '0I 10/ TO <br /> Worksheet Checked By: 0N- Date:---(i-14 6 frozo <br /> REVISED 11/27/2019 <br />