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_ • • <br /> E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> imm WASHINGTON <br /> PROJECT ADDRESS: 1718 PINE ST Permit#: B2104-061 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CREATE 400 SF DETACHED ADU W/ATTACHED GARAGE&PORCH <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 /> Si <br /> NITARY SEWER: <br /> / DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> New Connection to main plus connections to building 0 New Connection, Size CI Per Cost Estimate <br /> Alteration 0 Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity ❑Fewer System Development Fee Total: $ <br /> ❑ Reconnection to stub iI''"' ,ater Service Line(behind meter),Size <br /> ❑ Backwater Valve t3ackflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED I;1 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> Virr6A-S s►ct u NE XT Sfro <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for eference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3 " Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ ❑jgackflow Prevention (Outside Building): 0 DCDA <br /> o ackflow Prevention (Outside Building): 0 DCVA I/NOT REQUIRED <br /> tif NOT 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 /> ❑Fes, 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 /> Nackflow 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 /> STjORMW4TER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> YES, See Attached calcul Io s/credit 0 YES,Traffic Mitigation Total:$ <br /> To be added on PW"( 7 � To be added on Q /❑ See Attached for calculations/credit <br /> Quantity charged L. 0 SF Quantity c arged_A-' F MINOT REQUIRED <br /> QTY is q ;o n o' '✓ p all hard surfaces QTY is' Roof only ti_.__.._Ira surfaces <br /> 'WJ +V �j-Zit <br /> ❑ NOT REQUIRED $ LEA 7J1 <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (n assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> CIYES-TYPE: 0 SFR 0 DUPLEX ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> `DLW a ee Attached Letter,2 copies (Permit Techs to iss one co y tp p licant with permits, scan one copy to Jeffrey Marks) <br /> Wigital copy attached to permit record, Permit# ZfO_a <br /> aved to Address Folder in Development Tech File jr118 P i FE 5 I.o f p N IT <br /> ❑ NOT REQUIRED v <br /> FIRE SPRINKLERS REQUIRED? <br /> W❑ ES-Type <br /> IOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> 0 Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Ins ections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: 41-16 Date: �z <br /> Worksheet Checked By: ;:,�-2_X 5e— Date: c-7/2-t: /-z..-24 <br /> REVISED 11/27/2019 <br />