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0 • <br /> - E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 10632 ROSEWOOD AVE Permit#: B2104-020 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: REPL EXTG MOBILE W/NEW 30'X64' MFH TO BE USED AS 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 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 -❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑,;' ap-off,quantity ❑ .ewer System Development Fee Total: $ <br /> `Reconnection to stub 0 ater Service Line(behind meter),Size / <br /> • Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT 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:$ ackflow Prevention (Outside Building): ❑ DCDA <br /> • ackflow Prevention (Outside Building): 0 DCVA sr NOT REQUIRED <br /> 410\10T 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 /> V❑ es, Quantity , See attached for reference. <br /> 1 NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ rackflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> ' • OT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> ❑ RMW�ITER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ES,oSee Attached for ca cula sons/credit m�//�� 0 YES,Traffic Mitigation Total:.$ <br /> To be added on PW - 2_ To be added on 2. 0 —Vfi0/ See Attached for calculations/credit <br /> Quantity charged SF Quantity c arged 24f SF IDIOT REQUIRED <br /> QTY is 0 Groun my II hard surfaces QTY is Roof only 0 all hard surfaces <br /> $ jI`t 1t $ _ <br /> ❑ NOT REQUIRED • ' ' • <br /> • <br /> Additional Checklists: <br /> qrDRESS LETTE REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> [ YES— PE:1�j SFR 0 DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY ❑ COMMERCIAL <br /> Jee Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> igital copy attached to permit record, Permit# <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT R QUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ ES—Type �! p r <br /> OT REQUIRED Ft <br /> 6C O MNT O i(�-,TLI ;1.1.f. S REGT�Reason: 6C 1 � � t i I•G <br /> PLIC WORKS PERMIT QUIRED? <br /> ES, Permit#PW _ <br /> 6?"Stormwater NPD S ab Completed in TRAKiT [314A Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: 7. ..-. <br /> Date: L6j Z <br /> oZ) <br /> Worksheet Checked By: 7 /� Date: g fg,. / <br /> REVISED 11/27/2019 <br />