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• 111 <br /> - E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1501 WALNUT ST Permit#: B2103-017 <br /> TENANT: LUCKY MARKET <br /> DESCRIPTION OF WORK: CONSTRUCT 150 SF ENCLOSURE LOCATED IN PARKING LOT <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, quantit ❑ Sewer System Development Fee Total: $ <br /> ❑ Reconnectio o stub 0 Water Serv. Line(behind meter), Size <br /> Backwate alve 0 Backflo revention (Outside Building): 0 RPBA or❑ DCVA <br /> NOT R UIRED 'NOT QUIRED <br /> Explan ion/Utility Permit#: Expl ation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0%" Detect eter Only, Service Size <br /> ❑Water Syste Development Fee Total:$ 0 Backflo Prevention (Outside Building): 0 DCDA <br /> Cl Backflow revention (Outside Building): ❑ DCVA a/ el- QUIRED <br /> NOT QUIRED pl ation/Utility Permit#: <br /> E pl tion/Utility Permit#: <br /> WATER DEP TMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qua ity , See attached for reference. <br /> tc-NOT QUIRED <br /> Plu bing P nuts (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ ackflow evention (Inside Building): 0 DCVA(for Domestic service) CIRPBA(for Domestic service) 0 DCDA(for Fire service) <br /> gNOT R UIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building ermit) <br /> STORMWATER SYST DEVELOPMENT FEES: TRAFFIC M IGATION FEES: <br /> ❑YES, 0 See Atta ed for calculations/credit 0 YES,Tr ffic Mitigation Total:$ <br /> To be added o W To be added on ❑ S Attached for calculations/credit <br /> Quantity ch ed SF Quantity charged SF IIOT EQUIRED <br /> QTY is ❑ round only 0 all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ $ <br /> NOT QUIRED <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 ❑ INFILL DWELLING 0 MULTI-FAMILY ❑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 atta hed to permit record, Permit# <br /> ❑ Saved to Ad ss Folder in Development Tech File <br /> '1941NOT REQUIRED <br /> FIRE SPRINKLE S REQUIRED? <br /> ❑ ES—Type <br /> NOT RE IRE <br /> Reason: <br /> PUBLIC WO KS PERMIT REQUIRED? <br /> ❑YES, Pe it#PW <br /> Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> 4NOT EQUIRED <br /> Worksheet Completed By: 11/4\k Date: 31 i3 121 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />