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• • <br /> RE E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 203 MADISON AVE Permit#: B2106-044 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW ADDITION 358 SF CONSISTS OF NEW BEDROOM/BATHROOM/LAUNDRY <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, ntity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconn tion to stub 0 Water Se .ce Line(behind meter), Size <br /> ❑ ack ter Valve ❑ ackflo revention (Outside Building): 0 RPBA or 0 DCVA <br /> O EQUIRED NOT QUIRED <br /> xpla ation/Utility Permit#: Expla ation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connec. n, Size -0 Per Cost Estimate <br /> ❑ Meter O y, Size ❑'/<" Detec eter Only, Service Size <br /> ❑Water ystem Development Fee Total:$ ❑0Backfl Prevention (Outside Building): 0 DCDA <br /> Vac ow Prevention (Outside Building): 0 DCVA V NOT EQUIRED <br /> O REQUIRED Expla ation/Utility Permit#: <br /> Exp nation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> Res, antity , See attached for reference. <br /> IOT EQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑yackflow revention (Inside Building): 0 DCVA (for Domestic service) ID RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> IOT RE UIRED <br /> ilding Permits (Note:Permit Technicians to add all items selected •_-• to associated Building Permit) <br /> T)RMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC TIGATION FEES: <br /> ES, 0 See Attached for calculations redit 0 YES raffic Mitigation Total: $ <br /> To be added on PW SAO%-0‘. To be added on ' 'oc' �% _ ee Attached for calculations/credit <br /> Quantitycharged SF Quantit cared 3 SF T REQUIRED <br /> QTY is❑ Ground only 0 all hard surfaces QTY is Roof• 'y❑a lea rfaces <br /> ❑ NOT REQUIRED $ t ! ‘'61 <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 0 INFILL DWELLING ❑ 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 /> ❑ D. ital copy attached to permit record, Permit# <br /> VN ❑paved to Address Folder in Development Tech File <br /> OT R UIRED <br /> FIRE SPRINKLER EQUIRED? <br /> ❑YES—Type O �g-� } �., '} I ,(KNOT RE RED I f 11 a 140 1 tom ,Lt� �)C�1 fT Xi 'i itou-55. <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> YES, Per it#PW <br /> tormwater D Tab C pleted in TRAKiT IVDA Tab Completed in TRAKiT 0 Inspecti ns Added in TRAKiT <br /> \0 NOT R QUIRED � � ��� <br /> heet Completed By: Date: <br /> Worksheet Checked By: 37137 Date:"7/` 'z-( <br /> REVISED 11/27/2019 <br />