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im 0 0 <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> iii WASHINGTON <br /> PROJECT ADDRESS: 2610 VIEWCREST AVE Permit#: PW1910-054 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW 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 EiC New Connection, Size 3/4t 'I -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair /1 '^ 'M1 (a�{ B Water System Development Fee Total: $ LOJ72,°0 <br /> ❑ Cap-off,quantity .���Y` I 1 WNW) it 1 la Sewer System Development Fee Total: $ 52TO.w <br /> I�Reconnection to stub `�0 f�}',� �'" LJ (� . ❑Water Service Line(behind meter), Size <br /> 1] Backwater Valve p w"` 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED , A (L00, <br /> �02-'0 <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: �/b /�/ <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 ❑3/4' Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 Backflow Prevention(Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑ DCVA SNOT REQUIRED <br /> it 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 /> ❑Yes, Quantity , See attached for reference. <br /> ITNOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> IRLNOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> 13,1 YES, Stormwater Total:$ 2 i CJ 32, 94 SkES,Traffic Mitigation Total: $- <br /> El Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credits.>. <br /> %All Hard Surface Fees to be added to Permit# p&/4/0 e s XNOT REQUIRED <br /> Pi(See Attached Spreadsheet for calculations/credit CL°P mg <br /> ❑ NOT REQUIRED r <br /> azyZAdditional Checklists: r't4Ce4 frittlif 2106 <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES—TYPE: I3CSFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> See Attached Letter,2 copies(Permit Techs to issue one copy to Applicant with permits, scan one copy to Jeffrey Marks) <br /> Digital copy attached to permit record, Permit# Pcolei)0 ^ Db"zif <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> NOT REQIIJIRED <br /> Reason: K) ItJ 3Sd dF <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> , YES, Permit#PW /ar/p 0j�f <br /> pi Stormwater NPDES Tab mpleted in TRAKiT '"ADA Tab Completed in TRAKiT III Inspections Added in TRAKiT <br /> CI NOT REQUIRED <br /> Worksheet Completed By: - Date: C9''tk. O c/�7.o�j <br /> /1 ✓ <br /> Worksheet Checked By: Date: 411 11 I tee <br /> REVISED 11/27/2019 <br />