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0 • <br /> im E VE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> imm WASHINGTON <br /> PROJECT ADDRESS: 1528 GRAND AVE Permit#: C1909-002 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADDTN &REMODEL TO EXTG SFR <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigaaffon, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVI : (Attach Calculation&Cost Est.) <br /> ❑ New Connection to in plus connections to building 0 New Connection, Siz - 0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size 0 Per Cost Estimate <br /> ❑ Repair 0 Water System velopment Fee Total:$ <br /> ❑Cap-off,quanti 0 Sewer Syst Development Fee Total: $ <br /> ❑ Reconnectio o stub 0 Water Se ice Line(behind meter), Size <br /> ❑ Backwater lye 0 Backflo Prevention (Outside Building): 0 RPBA or❑ DCVA <br /> ANOT REQ IRED .SOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: of Including Cost Estimates) FIRE SERVICE: (A ch Cost Estimate/Request for Reference) <br /> ❑ New Connection, Si e ❑ New Connecti , Size - ❑ Per Cost Estimate <br /> ❑ Meter Only, Size ❑%" Detect ter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 Backflow revention (Outside Building): ❑ DCDA <br /> ❑ Backflow Pre -ntion(Outside Building): ❑ DCVA 1214NOT QUIRED <br /> }a-NOT REQ ED Explana ion/Utility Permit#: <br /> Explanatio A tility Permit#: <br /> WATER DEPART ENT COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> SNOT REQU ED <br /> Plumbin Pe, its . -:Permit-Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Pr-'entio nside Building): ❑ D VA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> NOT REQ RED <br /> Buildin• `ermits (Note:Permit Technician. to add all items selected below to associated Building Permit) <br /> STORMW, ER SYSTEM DEVELOPMENT FEE TRAFFIC MITIGATION FEES: <br /> bt.YES, Stu rmwater Total: $ 4 2$ '7 to ❑YES,Traffic Mitigation Total: $ <br /> ❑ Rocf Only Fee on Bldg Permit(ground and surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> All and Surface Fees to be added to 'ermit# P i 2oc>2- C,0(6 154JOT REQUIRED <br /> ❑ Se: Attached Spreadsheet for calc. ations/credit <br /> ❑ NOT R'DUIRED <br /> Additiona Checklists: <br /> ADDRESS LETT - ' e • ' 'D? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: 0 SFR • DUPLEX ❑ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See Attache,. Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digital co. attached to permit record, Permit# <br /> ❑Saved tr Address Folder in Development Tech File <br /> A-NOT REQUIRE& <br /> FIRE SPRINKLERS SQUIRED? <br /> ❑YES—Type <br /> le—NOT REQUI D <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> (! 'ES, Permit#PW 7-ao' ov F, <br /> jEr-Stormwater NPDES Tab Completed in TRAKiT %,ADA Tab Completed in TRAKiT ptInspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed B : '�-— Date: 0 2-1 Go I Zv&o <br /> Worksheet Checked By: _A * Date: 'AO[-WC <br /> REVISED 11/27/2019 <br />