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III • <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1504 50TH ST Permit#: B2006-014 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADD NEW SLOPED CONCRETE WALKWAY,GRAB BARS IN MASTER BATHRM <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 -❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> 0 Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity ewer System Development Fee Total: $ <br /> • Reconnection to stub 0 ter Service Line(behind meter), Size <br /> r❑ :ackwater Valve 0 a kflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> •T REQUIRED T REQUIRED <br /> 'Ex. anation/Utility Permit#: Exp nation/Utility Permit#: <br /> -RIGATION 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 " Detect Meter Only, Service Size <br /> Water System Development Fee Total: $ B ckflow Prevention (Outside Building): ❑ DCDA <br /> ckflow Prevention (Outside Building): 0 DCVA <br /> N T REQUIRED <br /> k .( N T REQUIRED Ex nation/Utility Permit#: <br /> \ Expl nation/Utility Permit#: <br /> ATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> Zes, Quantity , See attached for reference. <br /> C, T REQUIRED <br /> I robing Permits (Note:Permit Technicians to dd all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ :ackflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> • •T REQUIRED <br /> ;, t ild►ng Permits (Note:Permit Technicians t add all r ected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES- TRAFFIC MITIGATION FEES: <br /> Y Stormwater Total: $ J3 2-7 S,Traffic Mitigation Total: $ <br /> oof Only Fee on Bldg Permit(ground hard su `� e o PW Ppp�� 't See Attached for calculations/credit <br /> All Hard Surface Fees to be added to.Permit#rf 1a�� v 11�N T REQUIRED <br /> OSee Attached Spreadsheet for calculations/credit <br /> • OT 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—TYPE: 0 SFR 0 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# <br /> ❑Saved to Address Folder in Development Tech File <br /> 4NJJT REQUIRED <br /> ' - SPRINKLERS REQUIRED? <br /> rEl S—Type <br /> •T REQUIRED <br /> Re s.n: <br /> P. 7 IC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> NOT REQUIRED <br /> Worksheet Completed By:.0?" Date: 0-7 Ito Ite zc� <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />