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E V E R E T T <br /> . • <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1507 WALL ST Permit#: PW2103-022 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: OVERLAY NEW ASPHALT ONTO EXTG <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 -0 Per Cost Estimate <br /> ❑Alteration ❑Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair ❑Water System Development Fee Total:$ <br /> ❑ Cap-off quantity ❑ Sewer System Development Fee Total:$ <br /> ❑ Reco ection to stub ❑Water rvice Line(behind meter), Size <br /> Bac ater Valve 0 Bac w Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> inkNO REQUIRED klq REQUIRED <br /> Expl nation/Utility Permit#: Expl nation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Conner'on, Size 0 New Con ection, Size -0 Per Cost Estimate <br /> ❑ Meter Only ize 0 3/4'Det t Meter Only, Service Size <br /> ❑Water Sy em Development Fee Total:$ 0 :ac ow Prevention(Outside Building): 0 DCDA <br /> pliBackflow revention (Outside Building): 0 DCVA ►✓ REQUIRED <br /> D NOT R UIRED E anation/Utility Permit#: <br /> Explanati n/Utility Permit#: <br /> WATER DE ARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Q ntity , See attached for reference. <br /> f mNOT EQUIRED <br /> Plumbin Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflo Prevention (Inside Building): ❑ DCVA(for Domestic service) 0 RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> NOT QUIRED <br /> Building Permits (Note:Permit Tec ' ians to add all items selected below to associated Building Permit) <br /> (STORMWATER SYSTEM DEVELOPMENT FE TRAFFIC MITIGATION FEES: <br /> ti(YES, ( See Attached for calculations/credit 0 YE ,Traffic Mitigation Total:$ <br /> To be added on PW .(Q3-012 To e added on See Attached for calculations/credit <br /> Quantity charged ,r 600 SF Qu tity charged SF 9 T REQUIRED <br /> QTY is"Ground only 0 all hard surfaces QT is 0 Roof only 0 all hard surfaces <br /> NOT REQUIRED <br /> A tonal Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes( w assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: 0 SFR 0 DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ ee Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> • ligital copy attached to permit record, Permit# <br /> ■ Saved to Address Folder in Development Tech File <br /> NO r REQUIRED <br /> FIRE SPRI KLERS REQUIRED? <br /> ❑YES— pe <br /> 97, NOT EQUIRED <br /> -as n: <br /> P BLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW 0 3 -0 1t <br /> ❑Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: \i(41� Date: <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />