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EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1707 RUCKER AVE Permit#: B2012-019 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONSTRUCT A NEW 624 SQ FT DETACHED, UNHEATED GARAGE <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 ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> O Repair 0 Water System Development Fee Total:$ <br /> ❑Cap-off,quantity 0 Sewer System Development Fee Total:$ <br /> O Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or❑ DCVA <br /> KNOT REQUIRED 1 '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 ❑3/4" Detect Meter Only, Service Size <br /> 0 Water System Development Fee Total:$ ❑ Backflow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA NOT REQUIRED <br /> NOT REQUIRED Explanation/Utility Permit#: <br /> xplanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> El Yes, Quantity , See attached for reference. <br /> KNOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ ackflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> 1 NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENLFEES: TRAFFIC MITIGATION FEES: <br /> , <br /> YES, Stormwater Total: $ ‘ vim,d 0 YES,Traffic Mitigation Total: $ <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) ❑See Attached for calculations/credit <br /> All Hard Surface Fees to be added to Permit# 24lz.-0 6i IX NOT REQUIRED <br /> ee Attached Spreadsheet for calculations/credit <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 /> I',t(NOT REQUIRED E9 FEE @N 1.1ett Of MTEII3Tt0/) <br /> FIRE SPRINKLERS REQUIRED? 14-1-3 50.FT, I, 0 t5.% <br /> � <br /> NOT REQUIRED YES—Type kDDE D 'P® `--- 2 <br /> QW 2oQZ- 0 t4 <br /> Reason: <br /> PU LIC WORKS PERMIT REQUIRED? <br /> ES, p9rmit#PW a-ok^Z.- 0 tk <br /> t Stormwater NPDES Tab Completed in TRAKiT 'DADA Tab Completed in TRAKiT liirInspections Added in TRAKiT <br /> ❑ NOT REQUIRED nn� <br /> Worksheet Completed By: 1�� Date: 2'U 4t I LQ <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />