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• • <br /> E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4405 RUCKER AVE Permit#: B2009-025 <br /> TENANT: MILKHOUSE LLC <br /> DESCRIPTION OF WORK: TI 1962 SF AND SOME DEMO-MILKHOUSE LLC <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 ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ❑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 <br /> Backwater Valve ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> NOT REQUIRED KNOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <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/" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ ❑ Backflow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention(Outside Building): 0 DCVA RIOT REQUIRED <br /> ►" OT REQUIRED Explanation/Utility Permit#: <br /> 4,alanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> 1 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 /> fgNOT 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: A- <br /> *ES, Stormwater Total:$ -0tt.2\ 'ES,Traffic Mitigation Total: $ 4-`it d 3 <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) $ See Attached for calculations/credit <br /> All Hard Surface Fees to be added to Permit# P�N120�0 -01�j ElNO``�r REQUIRED t <br /> See Attached Spreadsheet for calculations/credit I N <br /> ❑ NOT REQUIRED TRAILtr <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: 0 SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ 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# <br /> ❑ Saved to Address Folder in Development Tech File <br /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> l$;NOT REQUIRED <br /> Reason: <br /> U LIC WORKS PERMIT REQUIRE IV <br /> YES, Permit#PW 10 10 — 015 <br /> ❑Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED 11 <br /> Worksheet Completed By: 1'��R Date: 10 401 2� <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />