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■. E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> N om WASHINGTON <br /> PROJECT ADDRESS: 6402 HIGHLAND DR Permit#: PW2009-031 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: DEMO EXTG SFR, BUILD NEW SFR W/ATTACHED GARAGE <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 /> ❑Alteration 0 Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ❑Water System Development Fee Total: $ <br /> 0 Cap-off, quantity 0 Sewer System Development Fee Total:$ <br /> Reconnection to stub 110Nater Service Line(behind meter),Size ilk <br /> ❑ Backwater Valve ❑ Backflow Prevention (Outside Building): 0 RPBA or❑ DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: ( ek3AI 'ft) I.X1STt <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size 0 g/<" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ ❑ Backflow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA kNOT REQUIRED <br /> lit-NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f 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): ❑ DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> TS<NOT 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 /> RYES, Stormwater Total: $ tetaL°5- ❑YES,Traffic Mitigation Total:$ <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> All Hard Surface Fees to be added to Permit# Via 20®Gli' 0 St NOT REQUIRED <br /> lirSee Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> IXYES—TYPE: IRSFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> See Attached Letter,2 copies(Permit Techs to issue one copy o applicant with permits, scan one copy to Jeffrey Marks) <br /> Digital copy attached to permit record, Permit# ?lei 2po - 0 3[i <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT R QUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> KNOT REQUIRED <br /> Reason: <br /> FUBLIC WORKS PERMIT REQUIRED? <br /> YES, Per, it#PW <br /> c,,tormwater NPDES Tab Completed in TRAKiT ADA Tab Completed in TRAKiT w nspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Mk Date: / <br /> Worksheet Checked By: V4—. Date: Ill 1 -0 <br /> REVISED 11/27/2019 <br />