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• • <br /> E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 5426 SEAHURST AVE Permit#: B2006-015 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADDITION TO EXISTING 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 /> ❑ New Connection to main plus connections to building ❑New Connection, Size -0 Per Cost Estimate <br /> 0 Alteration ❑Meter Only, Size -❑ Per Cost Estimate <br /> ❑Repair 0 Water System Development Fee Total:$ <br /> ❑Cap-off, quantity ❑Sewer System Development Fee Total:$ <br /> ❑Reconnection to stub ❑Water Service Line(behind meter), Size <br /> ❑Backwater Valve ❑Backflow Prevention (Outside Building):❑ RPBA or❑ DCVA <br /> KNOT REQUIRED KNOT REQUIRED <br /> Explanation/Utility Permit#: KNOT <br /> 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 ❑3/"Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building): ❑ DCDA <br /> ackflow Prevention (Outside Building): CI DCVA 'NOT REQUIRED <br /> NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/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 /> KNOT 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) ❑ RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> KNOT 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 /> YES, Stormwater Total:$ 10•Sit ❑YES,Traffic Mitigation Total:$ <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# B 1006-016 NOT REQUIRED <br /> See Attached Spreadsheet for calculations/credit <br /> ❑NO REQUIRED <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 ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑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 attached to permit record, Permit# <br /> ❑Saved to Address Folder in Development Tech File <br /> KNOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> XNOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> NOT REQUIRED <br /> Worksheet Completed By: It 44440.4 ��h� Date: tO J(► � <br /> Worksheet Checked By: �.�p�i/.J as1 Date: A i‘l <br /> REVISED 11/27/2019 <br />