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in E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 5033 CLAREMONT WAY Permit#: B2106-006 <br /> TENANT: FABER CONSTRUCTION <br /> DESCRIPTION OF WORK: 2059 SF PARTIAL TI OF EXTG 4552SF BUILDING INTO OFFICES <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, quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ ackwater Valve 0 yackflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> OT REQUIREDOT 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 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0%" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 Vackflow Prevention (Outside Building): 0 DCDA <br /> • ackflow Prevention (Outside Building): 0 DCVA 4/NOT REQUIRED <br /> INIINOT 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 /> ❑ies, 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 /> Vackflow Prevention(Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> OT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> ST9IRMWJ TER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ES, See Attached r c cula io /credit 0 YES,Traffic Mitigation Total:$ <br /> To be added on PW . — To be added on ❑ See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF RIOT REQUIRED <br /> QTY is 0 Ground o a I h rd surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ rREQUIRED c�`LL3/ $ <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 /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑y ES—Type <br /> NOT REQUIRED <br /> Reason: <br /> viP LIC WORKS PERM T �UIROV ES, Per it#PW dj '�j` <br /> Stormwater NPDES Tab Completed in TRAKiT DADA Tab Completed in TRAKiT 0 Inspections dded in TRAKiT <br /> ❑ NOT REQUIRED � % � ®�� <br /> Worksheet Completed By: Date: <br /> / <br /> Worksheet Checked By: Date: 8 o11 jz.I <br /> REVISED 11/27/2019 <br />