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- S <br /> E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 2201 124TH ST SE Permit#: PW2002-034 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR AND DETACHED 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: DQMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> ❑ New Connection to main plus connections to building Idi New Connection, Size 6 ❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size - ❑ Per Cost Estimate <br /> ❑ Repair IN-Water System Development Fee Total: $_A.45'12.00 <br /> ❑ Cap-off, quantity Jfi Sewer System Development Fee Total: $_ 5,210,so <br /> ''gReconnection to stub 0 Water Service Line(behind meter), Size <br /> Backwater Valve ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑%" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑ DCVA 1NOT Id-NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Mity Pern tt# <br /> "' WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) ' <br /> Yes Quantity Q See attached for reference. r isLC- <br /> CI NOT REQUIRED is 661)4 <br /> P PerrnftTeeh#rrcrans to addra trnis selecte Iselor o Plumbing Permit for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): ❑ DCVA(for Domestic service) ❑ RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> Vi.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 /> YES, Stormwater Total: $ a 204.9Q DYES,Traffic Mitigation Total: $,2400.ob <br /> 11 Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> Midi Hard Surface Fees to be added to Permit# Pv47-40o2- 034 ❑ NOT REQUIRED <br /> El See 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 /> I, YES—TYPE: Il•.SFR 0 DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> Is See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> QrDigital copy attached to permit record, Permit#'R,,J 20o2- 03 4 <br /> -Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> fi YES—Type 131) <br /> ❑ NOT REQUIRED <br /> Reason: 0'S-rA.ac-C- o F -fig-WE.W4Y <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> &YES, P mit#PW 2-ov2-034 <br /> tormwater NPDES Tab Completed in TRAKiT TILADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed.1E37 <br /> Date: 5S141 I <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />