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- EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 7018 BEVERLY BLVD Permit#: B2007-007 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW SFR <br /> PW Reviewer to select all that a v below: II� <br /> Utility Permits (No . Permit Technicians to Create Utility Permit for Se , a r as ` •" ""�� %' <br /> SANITARY SEWER: DOMESTIC WATER ERVICE: (Attach Calculation&re Est. <br /> ❑ New Connectio to main plus connections to building ❑-Nevreonnection, Size -CI Per Cost Estimate <br /> Alteration r nly, S' e -0 Per Cost Estimate <br /> ❑ Repair Water Sys Development Fee Total:$ a'f'I t o.00 <br /> ❑ Cap-o quantity Sewer stem Development Fee Total: $ 5,%22.00 �® <br /> ❑ Rec nection to stub Wat Service Line(behind meter), Size V` combo `‘ <br /> o Ba water Valve ❑ Back ow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ T REQUIRED ❑ NOT REQUIRED c <br /> Explanation/Utility Permit#: �/�o� ` Explanation/Utility Permit#: U .O' <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Atta h Cost Estimate/Request for Reference) <br /> ❑ New Connecti , Size ❑ New C nectio ize -0 Per Cost Estimate <br /> ❑ Met Only, ize ❑3 " Detec r Only, Service Size <br /> ❑Wat Sy em Development Fee Total:$ 0 Backflow vention (Outside Building): 0 DCDA <br /> ❑ Back Prevention (Outside Building): 0 DCVA ,NOT UI D <br /> XNOT QUIRED Explana ion/Utility Permit#: <br /> Expl ation tility Permit#: <br /> WA ER D ARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Ye , antity , See attached for reference. <br /> QUIRED <br /> Plumbin; Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only <br /> ❑ Bac i 4w Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic se ' ire rvice) <br /> Ni NO` '. 0 UIRED <br /> :uilding Permits (Note:Permit Technicians to add all items selected below to associat uilding Permit) <br /> STORMWATER SYSTEM DEVELOP ENT FEES: FFIC MITIGATION ES: [ <br /> !'YES, See Attached for calc tions/credit YES,Traffic Mitig on Total:$ <br /> To be added on PW -°0 -0 1( To be added on ❑ See Attac for calculations/credit <br /> Quantity charged SF Quantity charged SF ❑ NOT REQU ED <br /> QTY is❑ Ground o all hard surfaces QTY is❑ Roof only❑all hard surfaces <br /> $ 5(2.5 $ - <br /> ❑ NOT REQUIRE <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: ►!SFR 0 DUPLEX 0 ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> i ' ched to permit record, Permit# a-43 O k -016 <br /> Saved to Address older in Development Tech File <br /> ❑ REQUIRED <br /> RE SPRINKLERS REQUIRED? <br /> ES-Type VS5) <br /> NOT REQUIRED <br /> ason: <br /> P U 3LIC WORK RMIT REQUIRED? <br /> YES, Permit#PW 7,00*-0 d\ <br /> 41\Stormwater NPDES Tab Completed in TRAKiT ,ADA Tab Completed in TRAKiT Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: 3(112,4 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />