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am EVE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 518 E BEECH ST Permit#: PW2112-036 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITE WORK FOR 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 El New Connection, Size 3 1 4 - 0 Per Cost Estimate <br /> ID Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 13 Water System Development Fee Total:$ 4311 ,o <br /> ❑ Cap-off, quantity El Sewer System Development Fee Total: $ 5 Sao,ao <br /> O Reconnection to stub 0 Water Service Line (behind meter), Size <br /> O Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: \A�-�Z-OZ' OL' Explanation/Utility Permit#: t4 IL O/"013 <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" 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 0 NOT REQUIRED <br /> 0-NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(Ifyes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> ❑ 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): 0 DCVA (for Domestic service) ❑ RPBA (for Domestic service) 0 DCDA (for Fire service) <br /> ❑ 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 /> ❑YES, 0 See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW 2.1 12-031. To be added on 0 See Attached for calculations/credit <br /> Quantity charged 3.23 4 SF Quantity charged SF I❑NOT REQUIRED <br /> QTY is I❑Ground only 0 all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ 8(v(a.a -7 $ <br /> o 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 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 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# <br /> ❑ Saved to Address Folder in Development Tech File <br /> O NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> U.NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit# PW L i Le o 3 t, <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT u-ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> VVorksheet Completed By: � �"�� Date: 2- /14 )24)Zz <br /> VVorksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />