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• • <br /> EVERETT <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> mom WASHINGTON <br /> PROJECT ADDRESS: 3610 W MUKILTEO BLVD Permit#: PW2004-007 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW 2580 SQ FT SFR <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 /> lll-Plew Connection to main plus L connections to building New Connection, Size 4'' -0 Per Cost Estimate <br /> ❑Alteration Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair L Water System Development Fee Total:$ 4, r2 od <br /> ❑ Cap-off, quantity %-Sewer System Development Fee Total: $ 5,2'0, o0 <br /> ❑ Reconnection to stub ❑Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): ❑ RPBA or 0 DCVA <br /> ❑ NOT REQUIREDn � ( ,, ❑ NOT REQUIRED t ' .�,�,�} <br /> Explanation/Utility Permit#: 2...6 — 6(,cal/ Explanation/Utility Permit#: U. PC3 ( r-© <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: ( ach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Si 0 New Connec' n, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size ❑3/4" Detect eter Only, Service Size <br /> ❑Water System evelopment Fee Total:$ 0 Backflow revention(Outside Building): 0 DCDA <br /> ❑ Backflow Pr ention (Outside Building): 0 DCVA ELNOT QUIRED <br /> ,gl NOT RE IRED Explana ion/Utility Permit#: <br /> Explanatio Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> ❑ NOT REQUIRED <br /> Plumbing Pe its (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow P vention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> tf NOT RE IRED <br /> Building Permits (Note:Pe it Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATIO FEES: <br /> OYES, Stormwater Total: $ o 4 &8 ,[$'YES,Traffic Miti tion Total:$ 244 00.06) <br /> Roof Only Fee on BI Permit(ground hard surfaces fee on PW Permit) ❑ See Atta ed for calculations/credit <br /> fit; All Hard Surface F es to be added to Permit# "Pw..t2av 4-00i ❑ NOT REQU ED <br /> See Attached S eadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER RE.UIRE P (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES-T�Y,,PE: IrSFR 0 aUPLEX 0 ADU 0 INFILL DWELLING CI MULTI-FAMILY0 COMMERCIAL <br /> E 8ee Attached Le er,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ITDigital copy att. hed to permit record, Permit# #N Zoo 4-oo-� <br /> Cr-Caved to Add -ss Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS SQUIRED? <br /> ❑YES-Type <br /> I NOT REQ ED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> 0-.YES, Permit#PW 208 4-oa7 <br /> Stormwater NPDES Tab Completed in TRAKiT DADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED -__:, <br /> Worksheet Completed By:k Date: O 5 f 7 /2 o Zcl (20 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />