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4877- 110 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/6/2017 <br /> Permit#: PW1707-006 <br /> PROJECT ADDRESS: 859 LOCUST ST <br /> DESCRIPTION OF WORK: NEW COMMUNITY CLUBHOUSE-GRANDVIEW APTS <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: HOUSING AUTHORITY OF EVERETT NAME: HOUSING AUTHORITY OF EVERETT <br /> ADDRESS: PO BOX 1547 ADDRESS: PO BOX 1547 <br /> EVERETT,WA,98206-1547 EVERETT,WA, 98206-1547 <br /> PHONE: PHONE: 4253391004 <br /> EMAIL: EMAIL: <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?,kYES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: 8/7os — 4002-- <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> /lEtNO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑YES—Amount$ /I''M 0 YES—Amount$ <br /> 0 Meter Only, 0 Complete Service, Size p„/f. ^.4 4" Detect Meter Only, 0 Fire Service Size <br /> Explanation: �S'.rei"l'ice 11 117QS7 "ter aita?ly Explanation: <br /> O RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> 0 Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> ,. YES—Amount$ 7Z New Connection. Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> )St'YES—Amount$ /O 947 ❑ See Attached Spreadsheet 7 rQ/-2 - c/ ,L//C-e a 44 1:ye -S�� <br /> ❑ NO—No Change of Use/Other per' prCVinu.s wl¢.efli disc03510° <br /> Explanation: 2OI 9 ( CS o r•l 'f3 A-C4e . <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet �" a <br /> NO Ihls (fan Occcrsrly use 716 -4e G✓xiSit,g c,001Cer fret/ <br /> Wrwfb J T" C <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> AYES—TYPE Can_ ,irSee Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: g;14- <br /> REVISED 10/11/2016 <br />