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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> MEN WASHINGTON <br /> PROJECT ADDRESS: 518 E BEECH ST Permit#: B2110-048 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW 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 3/4"-❑ Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only, Size - ❑ Per Cost Estimate <br /> El Repair ❑ Water S m Development Fee Total: $ <br /> ❑ Cap-off uantity ❑ Sewer ystem Development Fee Total: $ <br /> ❑ Reco ection to stub ❑ Wa r Service Line (behind meter), Size <br /> ❑ Ba water Valve ❑ ckflow Prevention (Outside Building): ❑RPBA ❑ DCVA <br /> ® N T REQUIRED OT REQUIRED <br /> Ex nation/Utility Permit#ALREADY COVERED IN U2202-023. planation/Utility Permit#ALREADY COVERED IN U2202-023 <br /> IRRIGATION SE' ICE: (Not Including Cost Estimates) FIRE SERVIC : (Attach Cost Estimate/Request for Reference) <br /> ❑ New Conne' ion, Size ❑ New Co ection, Size -❑ Per Cost Estimate <br /> ❑ Meter Onl, , Size ❑ 3/4' De ct Meter Only, Service Size <br /> ❑ Water stem Development Fee Total $ ❑ Bac ow Prevention (Outside Building): ❑DCDA <br /> ❑ Backv:w Prevention (Outside Building). ❑DCVA ® N REQUIRED <br /> ® NO,' REQUIRED xplanation/Utility Permit# <br /> E planatio Utility Permit# <br /> WATER D ARTMENT COST ESTIMATE NEEDED-(if yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, antity , See attached for reference. <br /> ® NOT EQUI D <br /> P/U bin ermits(Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Backflow P evention (Inside Building): ❑DCVA (for Domestic service) ❑RPBA(for Domestic service) ❑DCDA (for Fire service) <br /> ® NOT EQUIRED <br /> Buil ing Permits (Note:Permit Technicians to add all items selected below to ass fated Building Permit) <br /> ORMWATER SYSTEM DEVEL PMENT FEES: TRAFFIC MITIGATION FEES: <br /> Ill YES, ❑ See Attached for culations/credit '),,Z YES,Traffic Mitigation Total: $3994.00 <br /> To be added on PW To be added on ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF ❑ NOT REQUIRED <br /> QTY is❑ Gro d only❑ all surfaces QTY is❑ Roof only ❑ all surfs s <br /> $ PJrZW) — oCt , <br /> a NOT REQ RED CCavr%.:�Lv k.s..4'04:_.Z TPv.I 2-11 L 'G 31c <br /> A• • " Tonal Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out ddress Letter from TRAKiT Print Menu and include) <br /> ® YES-TYPE ® SFR El 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#' 2.I1 C • 0 4 Qj <br /> ® Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES-Type 4 <br /> ® NOT REQUIRED <br /> Reason: �� <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ® YES, Permit#PW2206-03 <br /> ® Stormwater NPDES Tab Completed in TRAKiT ® ADA Tab Completed in TRAKiT ® Inspections Added in TRAKiT <br /> El NOT REQUIRED <br /> ✓ <br /> Worksheet Completed By. -/:G-r � 1' Date: p [D (0 4-1 tu L Z <br /> ..-- <br /> Worksheet Completed By Date. <br /> REVISED 12/22/2021 <br />