4953 ELM ST B 2025-01-06 - Laserfiche WebLink

_ • _ EVERETT PUBLIC WORKS REVIEW WORKSHEET INENI WASHINGTON PROJECT ADDRESS: 4953 ELM ST Permit#: B2107-047 TENANT: [TenName] DESCRIPTION OF WORK: NEW 1100 SF SFR WITH EXTG 736 SFR TO CONVERT TO ADU PW Reviewer to select all that apply below: Utility P rmits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) SANITA SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) ❑ New onnection to main plus connections to building 0 New Connection, Size -❑ Per Cost Estimate 'Alt ation 0 Meter Only, Size -❑ Per Cost Estimate ❑ R air ❑Water S stem Development Fee Total: $ ❑ p-off,quantity ❑ Sewe ystem Development Fee Total: $ ❑ Reconnection to stub *Wa r Service Line(behind meter),Size 3 ❑ Backwater Valve 0 B flow Prevention (Outside Building): ❑ RPBA or❑ DCVA ❑ NOT REQUIRED ❑ T REQUIRED 2.IO� Explanation/Utility Permit#: LJ�` Explanation/Utility Permit#: IRRIGATION SER CE: (Not Including Cost Estimates) FIRE SERVICE. (Attach Cost Estimate/Request for Reference) ❑ New Connect. , Size 0 New Conn tion, Size -0 Per Cost Estimate ❑ Meter Only, aze ❑%" Dete Meter Only, Service Size ❑Water Sys;-m Development Fee Total:$ 0 Back Prevention (Outside Building): 0 DCDA ❑ Backflo 'revention (Outside Building): ❑ DCVA 'NO REQUIRED , NOT QUIRED Ex nation/Utility Permit#: Explanation/Utility Permit#: WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PWReviewerto send cost estimate request to Water Department) ❑Yes, Quantity , See attached for reference. NOT REQUIRED Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) ❑ Backflow Prevention(Inside Building): 0 DCVA(for Domestic service) ❑ RPBA(for Domestic service) 0 DCDA(for Fire service) ...jib NOT REQUIRED Building Permits (Note:Permit Technicians to add all items selected b low to associated Building Permit) STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: YES,$See Attached for calculations/credit ❑YES,Traffic Mitigation Total:$ To be added on PW To be added on 8 - col* 0 See Attached for calculations/credit Quantity charged SF Quantity charged G 9 SF lit NOT REQUIRED QTY is❑ Ground only 0 all hard surfaces QTY is 0 Roof ly St all hard surfaces $ $ ❑ NOT REQUIRED Additional Checklists: ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) 0-YES—TYPE: ❑ SFR 0 DUPLEX I3ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL ti See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) -Digital copy attached to permit record, Permit# z a 41 ((Saved to Address Folder in Development Tech File ❑ NOT REQUIRED FIRE SPRINKLERS REQUIRED? ❑YES—Type A'NOT REQUIRED Reason: PUBLIC WORKS PERMIT REQUIRED? ❑YES, Permit#PW 0 Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT XNOT REQUIRED / Worksheet Completed By: �T,9L Date: i Worksheet Checked By: Date: iftz9/20z REVISED 11/27/2019