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110 <br /> 12 E V E R E T T • PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3531 NORTON AVE Permit#: PW1902-028 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITE DEVELOPMENT FOR NEW DUPLEX <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 /> r New Connection to main plus connections to building ra£,�.I. New Connection, Size / '' -0 Per Cost Estimate <br /> `Alteration ►-k 'L❑ Meter Only, Size -0 Per Cost Estimate <br /> /❑ Repair ' `'r 16 litWater System Development Fee Total: $ ,34 57 <br /> ❑ Cap-off, quantity re-Sewer System Development Fee Total: $ 4/2_. I <br /> 1StReconnection to stub s-r ac 0-Water Service Line (behind meter), Size <br /> ❑ Backwater Valve ""£ ""0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ElNOT REQUIRED on•i'-rib 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Att.• Cost Estimate/Request for Reference) <br /> ❑ New Co ection, Size 0 New Connectio•, Size -0 Per Cost Estimate <br /> ❑ Meter ly, Size 0 3/4" Detect er Only, Service Size <br /> ❑Wate System Development Fee Total: $ ❑ Backflo 'revention (Outside Building): 0 DCDA <br /> ❑ Ba flow Prevention (Outside Building): 0 DCVA NOT - QUIRED <br /> T REQUIRED Explanation/Utility Permit#: <br /> Ex lanation/Utility Permit#: <br /> WATER DE ARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Q ntity , See attached for reference. <br /> AINO EQUIRED <br /> Plumbing rmits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow revention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> ANOT QUIRED <br /> Building Permits (Not • ermit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTE EVELOPMENT FEES: TRAFFIC MITIGA N FEES: <br /> YES, Stormwater T al: $ 7-75'70 Ur—YES,Traffic itigation Total:$ ?`l6c?c,0 <br /> ❑ Roof Only F e on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See ached for calculations/credit <br /> AJI Hard rface Fees to be added to Permit# 'Q.,-I 12.02-62u8 0 NOT QUIRED oO tom Du tux <br /> ❑ See A ched Spreadsheet for calculations/credit �� <br /> ❑ NOT RE IRED •—ZNOI) g{ CVr <br /> 1-2 loo Nu-1)1)6 <br /> Additional Checklists: <br /> ADDRESS LET REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES—TYP : ❑ SFR DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ee Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> igital copy attached to permit record, Permit# pv4 14 o Z -0 Z$ <br /> fjt.Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED. <br /> FIRE SPRINKL RS REQUIRED? <br /> 1 'ES—Type /3 D <br /> ❑ NOT R RED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> 16-YES, Permit#PW i go Z-o24- <br /> --Stormwater NPDES Tab Completed in TRAKiT I - DA Tab Completed in TRAKiT 11 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: 9/&/9 <br /> Worksheet Checked By: Ar-A, Date: 9 fg 1 2011 <br /> REVISED 4/24/2019 <br />