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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> imis WASHINGTON <br /> PROJECT ADDRESS: 4330 HOYT AVE Permit#: B1908-042 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADD 2 GARAGES, BEDROOMS AND BATHROOMS <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 ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration ❑ Meter Only, Size -0 Per Cost Estimate <br /> -0 Repair ❑Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): ❑ RPBA or 0 DCVA <br /> F-440T REQUIRED till-NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/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, Size ❑'/" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention(Outside Building): 0 DCVA e-NOT REQUIRED <br /> A.-1110T REQUIRED Explanation/Utility Permit#: <br /> Explanation/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 /> p-PJOT 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 /> ,NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> AYES, Stormwater Total: $ 41i. 4t', ❑YES,Traffic Mitigation Total:$ <br /> Et-goof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) ❑ See Attached for calculations/credit <br /> ❑All Hard Surface Fees to be added to Permit# INOT REQUIRED <br /> ,(gt-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— PE: ❑ SFR IDUPLEX ❑ADU ❑ INFILL DWELLING 0 MULTI-FAMILY ❑ COMMERCIAL <br /> ;Mee Attached Letter, 2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> arDigital copy attached to permit record, Permit# e?sd t9/o- 0 t f4 e_ci No.uc <br /> ,r6aved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> SNOT REQUIRED <br /> Reason: <br /> ,PUBLIC WORKS PERMIT REQUIRED? <br /> ES, kemit#PW 19I0- C, [`i <br /> Stormwater NPDES Tab Completed in TRAKiT %ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: /0 !0 9 <br /> Worksheet Checked By: _ Date: 0 <br /> REVISED 4/24/2019 <br />