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- EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> mmmi WASHINGTON <br /> PROJECT ADDRESS: 1507 RUCKER AVE Permit#: B2101-021 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW DETACHED ADU-MODULAR HOME <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 /> olt Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑Cap-off, quantity 0 Sewer System Development Fee Total:$ <br /> ❑ Reconnection to stub *Water Service Line(behind meter), Size 3[4 " <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or❑ DCVA <br /> ❑ NOT REQUIRED p11 ❑ NOT REQUIRED i f /� t^ �Or7 ' <br /> Explanation/Utility Permit#: L r j-- NOT <br /> Utility Permit#: V/, k 2 !/ <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA s-NOT REQUIRED <br /> SNOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PWReviewerto send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> Iig-NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> F'NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ICES,d9 See Attached for calculations/credit 0 YES,Traffic Mitigation Total:$ <br /> To be added on PW To be added on 'ea-1D r-0 2/ 0 See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 34o SF Ig-NOT REQUIRED <br /> QTY is 0 Ground only 0 all hard surfaces QTY is Id-Roof only0 all hard surfaces <br /> $ $ BC• I <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> fES-TYPE: 0 SFR 0 DUPLEX I -ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> I2)See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> Digital copy attached to permit record, Permit# ' '2.ro <br /> aved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> SNOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> 0 Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> -NOT REQUIRED <br /> Worksheet Completed B Date: lZ102 14 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />