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0 • <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> iiimi WASHINGTON <br /> PROJECT ADDRESS: 1302 HOYT AVE Permit#: C1906-001 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: RELOCATE BASEMENT ACCESS DOOR/NEW COVERED PATIO/ADD APPROX <br /> PW Reviewer to select all that apply below: <br /> U . . rmits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> ANITARY§EWER: DOMESTIC WATER SERVICE: (Attach Calculation& Cost Est.) <br /> ❑ New Co nection to main plus connections to building 0 New Connection, Size -0 Per Cost Estimate <br /> ,•Itera' n 0 Meter Only, Siz - 0 Per Cost Estimate <br /> • Rep r 0 Water Syste evelopment Fee Total: $ <br /> -off, quantity 0 Sewer Sys Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water S ice Line(behind meter), Size <br /> ❑ Backwater Valve p Backfl Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED iS-NOT EQUIRED <br /> Explanation/Utility Permit#: n\\ — 06 Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: • of Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Si - 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑3/" Detect Meter Only, Service Size <br /> ❑Water System II-velopment Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Pre -ntion (Outside Building): 0 DCVA .NOT QUIRED <br /> SNOT REQ 'ED Explanation/Utility Permit#: <br /> Explanation/ tility Permit <br /> WATER DEPARTM COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> KNOT REQUIR <br /> Plumbing er "ts (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Preve ion(Inside Building): r: DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> ka-NOT REQUIR D <br /> Building Permits (Note:P: mit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DE ' LOPMENT FEES: TRAFFIC MITIG TION FEES: <br /> } YES, Stormwater Total: IU-1.44 0 YES,Traffi litigation Total: $ <br /> $Roof Only Fee on ' Idg Permit(ground hard surf ces fee on PW Per it) 0 See tached for calculations/credit <br /> 0 All Hard Surfac-' ees to be added to Permit#_(' `CLOG, tg NOT R QUIRED <br /> 1g See Attaches preadsheet for calculations/credit <br /> ❑ NOT REQUIR d <br /> Additional Checklis : <br /> ADDRESS LETTER RE IRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: ❑ SF ❑ DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See Att ed Letter, 2 copies (Permit Techs to iss o e copy o app 'c nt ith permits, scan one copy to Jeffrey Marks) <br /> ❑ Digital opy attached to permit record, Permit# <br /> ❑ Sav to Address Folder in Development Tech File <br /> VfNOT REQ ED <br /> FIRE SPRINKLERS R UIRED? <br /> ❑YES—Type <br /> pi NOT REQUIR <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> .YES, Permit#PW I Q s o - c Lo <br /> %Stormwater NPDES Tab Completed in TRAKiT leADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By. Date: /O ea S 0 1 9 <br /> Worksheet Checked By: Date: 10[I$1 UV\ <br /> REVISED 4/24/2019 <br />