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EVERETT <br />WASHINGTON <br />PROJECT ADDRESS: <br />TENANT: <br />DESCRIPTION OF WORK: <br />PUBLIC WORKS REVIEW WORKSHEET <br />6531 CYPRESS ST <br />Permit #: B2106-061 <br />[TenName] <br />NEW DETACHED (2) CAR GARAGE WITH ADU OVER GARAGE <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br />SANITARY SEWER: <br />❑ New Connection to main plus connections to building <br />,X Alteration <br />❑ Repair <br />❑ Cap -off, quantity <br />❑ Reconnection to stub <br />Sackwater Valve <br />is plan —0 REQUIRED 6 6 <br />Explanation/ Utility Permit #: lJ—.� <br />IRRIGATION SERVICE: (Not Including Cost Estimates) <br />❑ New Connection, Size <br />❑ Meter Only, Size <br />❑ Water Syste Development Fee Total: $ <br />WNOT <br />ackflow P vention (Outside Building): ❑ DCVA <br />UIRED <br />Expla ion/ Utility Permit #: <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size - ❑ Per Cost Estimate <br />Water System Development Fee Total: $ <br />❑ Sewer System Development Fee Total: $ <br />f6Water Service Line (behind meter), Size <br />�F3ackflow Prevention (Outside Building): ❑ RP A or ❑ DCVA <br />a.', JOT REQUIRED �jj <br />Explanation/ Utility Permit #: A-k -tk C)" <br />FIRE SERVICE: (Attach Cost Estimate/ Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ %" Detect MetepOnly, Service Size <br />❑ ackflow Pr rention (Outside Building): ❑DCDA <br />1OT R IRED <br />ExplarrStion/ Utility Permit #: <br />WATER DEP MENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />X, Qu ity See attached for reference. <br />T, QUIRED <br />Permits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />❑ packfloV46revention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />UIRED <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, ❑ See Attached for calculations / credit jj�� /� ❑ YES, Traffic Mitigation Total: $ <br />To be added on PW To be added on V " v ❑ See Attached for calculations / credit <br />Quantity charged SF Quantit�arge SF 640T REQUIRED <br />QTY is ❑ Ground jgly Wall hard surfaces $QTY is Roo on ❑all har surfaces <br />$ [yy <br />❑ NOT REQUIRE <br />Additional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (n w assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />Pf YES — T)LPE: ❑ SFR ❑ DUPLEX jff 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 />ur6igital copy attached to permit record, Permit # '�t*l 2-t011- 01-1 <br />Saved to Address Folder in Development Tech File <br />I/NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />17❑ YES —Type <br />NOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />41YES, Per it # PW !2j6y—Qa <br />VV Stormwater NPDES Tab Completed in TRAKiT (g ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: Date: in /0�hozq <br />Worksheet Checked By: Date: 10 13 U2( <br />REVISED 1112712019 <br />