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_ • <br /> EMI EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1425 SE EVERETT MALL WAY Permit#: K2201-001 <br /> TENANT: GAME ON NW <br /> DESCRIPTION OF WORK: ADD 5 PENDANT FIRE SPRINKLER HEADS AND 5 UPRIGHT HEADS <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: DOMESTI \ ATER SE- CE: (Attach Calculation &Cost Est.) <br /> ❑ New nnection to ain plus connections to building 0 New Conn . ion,Size/ -0 Per Cost Estimate <br /> ❑Alterati n 0 Meter Only, '••\e -0 Per Cost Estimate <br /> ❑ Repair 0 Water System b•-veltddpment Fee Total:$ <br /> ❑Cap-off, an • 0 Sewer System De•:'opment Fee Total: $ <br /> ❑ Reconnec to stub 0 Water Service Lin;(::- nd meter), Size <br /> ❑ Backwate lye ❑ Backflow Prevenf:n - Building): ❑ RPBA or❑ DCVA <br /> ❑ NOT R UI D ❑ NOT REQUIRED/ <br /> Explana' n/Utility Permit#: Explanation/Utility •ermit#: <br /> IRRI cl_,TION SE 7 ICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New .nnec:on, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Meter 0� '/ 3 ize 0 " Detect Meter Only, Service Size <br /> ❑Water Sys m Development Fee Total: $ "$,Backflow Prevention (Outside Building): DCDA <br /> ❑ Backflow ntion (Outside Building): 0 DCVA 0 NOT REQUIRED 1-1-0El 02� <br /> NOT RE. IRsD Explanation/Utility Permit#: U <br /> Explanatio/Utility Permit#: SS W �i�YG iStd>'1 /0 '-¢ <br /> WATER P RTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Wate Department) <br /> ❑Yes, Qua t , See attached for reference. <br /> ❑ NOT E I <br /> Plumb hermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow vention(Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> ❑ NOT RE I <br /> Building Permits ote:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWA SYSTE DEVELOPMENT FEES: TRAFFIC MI,\IG y ION FEES: <br /> ❑YES, 0 See A the for calculations/credit 0 YES,TraffiVtigation Total: $ <br /> To be added on To be added on 0 See Atta.f4\ed for calculations/credit <br /> Quantity charged SF Quantity charged SF 0 NOT REQUfr D <br /> QTY is 0 Ground my all hard surfaces QTY is 0 Roof only 0 all hard surfaces / <br /> $ $ <br /> ❑ NOT REQUIRED <br /> Additio al Checkl ts: <br /> ADDRESS L'\TTER RE,R UIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYP \❑SF�' ❑ DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See ' ,ac d Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digital c.4 attached to permit record, Permit# <br /> ❑ Saved to'':••ress Folder in Development Tech File <br /> ❑ NOT REQUIRED N <br /> FIRE SPRINKL S R UIRED? <br /> ❑YES—Type _ <br /> ❑ NOT REQUIR <br /> Reason: <br /> PUBLIC WO S ' RMIT REQUIRED? <br /> ❑YES, Permit\\"W <br /> ❑ Store cater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑NOT REQUI"E' <br /> I WorksheetCompletedBy: �� Date: ( �j7 (701' <br /> Worksheet Checked By: c Date: t 7/1 ! O 2#11 <br /> REVISED 11/27/2019 <br />