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• <br /> LEI EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> Nom WASHINGTON <br /> PROJECT ADDRESS: 5230 EAST DR Permit#: B2109-024 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CREATE ADULT FAMILY HOME IN LOWER LEVEL OF 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 -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter),Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> K,xNOT REQUIRED 0 NOT REQUIRED <br /> planation/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 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): 0 DCVA iifNOT REQUIRED <br /> *NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, 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 /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> y NOT 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 /> I (,YES, 0 See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW 2iIC--DO4 To be added on 0 See Attached for calculations/credit <br /> Quantity charged '3IE SF Quantity charged SF 14 NOT REQUIRED <br /> QTY is yl Ground only all hard surfaces QTY is 0 Roof only❑all hard surfaces <br /> $ -fof $ <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: 0 SFR 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# <br /> ❑ Saved to Address Folder in Development Tech File <br /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> I.NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> I AYES, Permit#PW Z(I0-O011" <br /> tormwater NPDES Tab Completed in TRAKiT DADA Tab Completed in TRAKiT C) Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: -' �� � Date: I t( G' 17OZI <br /> Worksheet Checked By: Date: /v/O6.--( .oZC <br /> REVISED 11/27/2019 <br />