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_ • • <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4120 COLBY AVE Permit#: B2004-029 <br /> TENANT: COLBY TOWNHOUSE <br /> DESCRIPTION OF WORK: NEW 3-STOREY WOOD-FRAMED TOWN HOUSE/DUPLEX <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (N.te:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, an, Irrigation, as selected below) <br /> SANITARY SEWER- DOMESTIC WATER : RVICE: (Attach Calculation&Cost Est.) <br /> KNew Connection to main plus t connections to building ■ ► -w Co •- - • '- • s' ate <br /> ❑Alteration 4! Meter Onl , S''e I" — -IPer Cost Estimat- <br /> ❑ Repair ri ater Syst; 'eve opment Fee Total:$ Z " O,. d a <br /> ❑ Cap-off, • =antity Ii Sewer Sy: em Development Fee Total: $ gat.33.oa. <br /> ❑ Reconno tion to stub L Water -rvice Line(behind meter), Size ►" <br /> ❑ Backw. er Valve 0 Backfl' Prevention (Outside Building): ❑ RPBA or 0 DCVA <br /> ❑ NOT 'EQUIRED ❑.NOT `EQUIRED <br /> Explan,tion/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION S ICE: (Not Including Cost Estimates) FIRE SERVIC-.(Attach Cost Estimate/Request for Reference) <br /> ❑ New Conn-.,'ion, Size 0 New Co ection, Size -0 Per Cost Estimate <br /> ❑Meter 0 , Size 0 3/" D- -ct Meter Only, Service Size <br /> ❑Water stem Development Fee Total: $ ❑ Ba ow Prevention (Outside Building): ❑ DCDA <br /> ❑ Back .w Prevention (Outside Building): 0 DCVA It( 4T REQUIRED <br /> WO ' REQUIRED E, '•lanation/Utility Permit#: <br /> pl.'ation/Utility Permit* <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> rii-Yes, Quantity See attached for reference. G �• l-�'z' •�� 1 �o*A*c+'C.- w�[4•c. .4'' 4�j <br /> ❑ NOT REQUIRED y� / <br /> Plumbing Pe mits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Pr ention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> &NOT REQ RED <br /> uilding Permits (Note:Permit Technicians to add all items selected w to associated Building Pee`it) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITI, •TION FEES: <br /> t YES, Stormwater Total: $ 62 •n-T WYES,Tra Mitigation Total: $ ((O,?✓4 4400 <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 Se-. •ttached for calculations/credit <br /> II Hard Surface Fees to be added to Permit#'Tv.(2do 4- o 2q 0 NOT r QUIRED <br /> See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> /1' <br /> Additional Chec lists: <br /> ADDRESS LETT REQUIR D? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> EYES-T PE: SFR UPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> Se Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> gital copy attached to permit record, Permit# ' N.42e 4- oLer 1..1.1%-rs -r <br /> aved to Address Folder in Development Tech File <br /> ❑ NOT QUIR <br /> FIRE SPRIN RS REQUIRED? <br /> ❑YES-Ty•-_ <br /> I, NOT R •UIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> OYES, Permit#PW 2.06 4-o 2 4' <br /> vi-Stormwater NPDES Tab Completed in TRAKiT eADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: /'1 /4-f Zo2.c� <br /> l <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />