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• • <br /> E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 5125 SEAHURST Permit#: PW1906-021 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: 6 LOT SHORT PLAT <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 /> tgNew Connection to main plus 5 connections to building g C 'New Connection, Size 3l4 -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair '"P•5v< u•$- 0 Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity 324 0 S4o ❑ Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub = '$'2. /20.co 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 13� ❑ NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/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 3 " Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Backflow Prevention(Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA fir NOT REQUIRED <br /> fa.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. r o �` •�.��. <br /> 01 NOT REQUIRED �,J'� U <br /> • <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside i•1ng o ly) <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire <br /> fig NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) ..2.02Z <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> YES, Stormwater Total: $ 11 to 4. 4 3 ❑YES,Traffic Mitigation Total:$ <br /> 0 Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> p4 All Hard Surface Fees to be added to Permit#- w,a q a to,- t 2 SNOT REQUIRED r <br /> ''See Attached Spreadsheet for calculations/credit fra' -3 <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 /> ❑YES—TYPE: 0 SFR 0 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 /> 0 Digital copy attached to permit record, Permit# <br /> ❑ Saved to Address Folder in Development Tech File <br /> SNOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> SNOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> AYES, Permit#PW (9d(o-62t <br /> Stormwater NPDES Tab Completed in TRAKiT FrADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: 6 3 /Z-4 ) z—ci <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />