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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1507 GRAND AVE Permit#: C1807-002 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: 3INTERIOR FIRE DAMAGE REPAIRS&NEW ADU-NON-STRUCTURAL <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 /> 'KNOT REQUIRED SNOT 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 -❑ Per Cost Estimate <br /> ❑ Meter Only, Size ❑3A" 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 ''NOT REQUIRED <br /> KNOT 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 /> $(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) 0 DCDA(for Fire service) <br /> • 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: $ 0 YES,Traffic Mitigation Total: $ <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> ❑All Hard Surface Fees to be added to Permit# )(NOT REQUIRED <br /> ❑ See Attached S readshee for alculations/credit <br /> 111,NOT REQUIRED Np R7,14 helet SiPeatitb <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 jiCADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> 01 See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> Bl Digital copy attached to permit record, Permit# CMT-OO2 <br /> .Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> ❑ NOT REQUIRED L <br /> Reason: FrA.. FiY£, by: 40 AsAv )ME. <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> 0 Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> NOT REQUIRED ak. tivcr .t <br /> Worksheet Completed By: Date: 31 I(� <br /> , i <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />