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E E R E T PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 1329 MADRONA AVE Permit #: PW1912-044 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: SITE WORK NEW (4) BEDROOM SFR <br />PW Reviewer to select all that amly below., <br />Utility Permits (N te: Permit Technicians to Create Utility Permit for Sewer, Water, Fire;RVICE: <br />d ,gation, as selected below) <br />SANITARY SEWER: DOMESTIC WATER (Attach Calculation & Cost Est.) <br />New Connection o main plus Q connections to building jX New Connectio ize - ❑ Per Cost Estimate <br />Alteration ❑ Meter Only, S' e - ❑ Per Cost Estimate <br />❑ Repair Water Sys Development Fee Total: $ A. p� 2• D <br />❑ Cap -off, q ntity O(Sewer S tem Development Fee Total: $ %S,� -re _ n v <br />❑ Reconn tion to stub ❑ Water ervice Line (behind meter), Size <br />❑ Back ter Valve l ''"� ❑ Bac ow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />ED <br />E❑xplaanation/ UtNO ility Permit #: L O© li Explanation/ n// Utility Permit #: " �• � � C� <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Att Cost Estimate / Request for Reference) <br />❑ New Connie , Size ❑ New Connecti Size - ❑ Per Cost Estimate <br />❑ Meter Only, ze ❑ 3/<<" Detect ter Only, Service Size <br />❑ Water Sy m Development Fee Total: $ ❑ Backflo revention (Outside Building): ❑ DCDA <br />❑ Backflo Prevention (Outside Building): ❑ DCVA J$. NOT EQUIRED <br />ONOT EQUIRED Ex nation/ Utility Permit #: <br />Expla tion/ Utili Permit #: <br />W ER D RTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, antity See attached for reference. <br />t0kLN REQUIRED <br />PI mbin Permits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />❑ Backfl Prevention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />�-NO EQUIRED <br />Building Permi (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />STORMWATER S TEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br />YES, Stormwa rTotal: $ 2Ci - % N(YES, Traffic Mitigation Total: $ �;�dn.00 <br />Roof On Fee on Bldg Permit (groundTiard surfaces fee on PW Permit ❑ See Attached for calculations / credit <br />❑ All Har Surface Fees to be added to Permit # �--� ❑ NOT REQUIRED <br />❑ See tached Spreadsheet for calculations / credi <br />❑ NOT R UIRED <br />Additional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKIT Print Menu and include) <br />ES —TYPE: A3FR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />Al -See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Mark <br />�-Digital copy attached to permit record, Permit # Tv4 i 4 <br />Saved to Address Folder in Development Tech File <br />❑ NOT REQUIRED <br />FIRE SPRINK S REQUIRED? <br />❑ YES —Ty <br />)&NOT QUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />$(,YES, Permit # PW '? u4 t1l7-- 0 4 4 <br />Z:Fstormwater NPDES Tab Completed in TRAKIT DADA Tab Completed in TRAKIT ❑ Inspections Added in TRAKIT <br />❑ NOT REQUIRED <br />Worksheet Completed By: Date: 0 & /it /2o r-D <br />Worksheet Checked By: Date: <br />cc vwcu i unity ro <br />