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• <br /> EVERETT <br /> cDD <br /> Ira PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 220 OLYMPIC BLVD Permit#: PW2007-035 <br /> TENANT: VA OUTPATIEI T CLINIC <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW VA OUTPATIENT CLINIC <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 /> X New Connection to main plus 2 connections to building ❑New Connection, Size -❑Per Cost Estimate <br /> ❑Alteration ❑Meter Only,Size -❑Per Cost Estimate <br /> ❑Repair E Water System Development Fee Total:$ 73.417.45 <br /> ❑Cap-off,quantity ESewer System Development Fee Total:$ 5,Q04.64 <br /> o Reconnection to stub EWater Service Line(behind meter),Size 3-Inchh <br /> ❑Backwater Valve 0 Backflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> ❑NOT REQUIRED i 21 r CI NOT REQUIRED <br /> Explanation/Utility Permit#: ` b ,,_( LIU V Explanation/Utility Permit#: 1/121 ti(r op� <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 E%"Detect Meter Only,Service Size 6-Inch <br /> ❑Water System Development Fee Total:$ 0 Backflow Prevention(Outside Building): 0 DCDA <br /> Backflow Prevention(Outside Building): E DCVA 0 NOT REQUIRED , A <br /> ❑NOT REQUIRED ^� O Explanation/Utility Permit#: 1/1 21 b(p-DD3 <br /> Explanation/Utility Permit#: 2,qt) b 3 <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. <br /> KNOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> X Backflow Prevention(Inside Building): ❑DCVA(for Domestic service) E RPBA(for Domestic service) E DCDA(for Fire service) <br /> ❑NOT REQUIRED ctoco— Dt <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) Lyo <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> EYES,)8(See Attached for calculations/credit EYES,Traffic Mitigation Total:$1 0.00 <br /> To be added on PW PW2007-035 To be added on E See Attached for calculat s/credit <br /> Quantity charged 47.100 SF Quantity charged SF ❑NOT REQUIRED � <br /> QTY is 0 Ground only EaII hard surfaces QTY is 0 Roof only 0 all hard surfaces veitA/4 1 I.'#1 )0A <br /> $ 12,401.43 $ VA❑NOT REQUIRED 0 l _Obi <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> EYES—TYPE: ❑SFR ❑DUPLEX 0 ADU 0 INFILL DWELLING ❑MULTI-FAMILY E COMMERCIAL <br /> E See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> E Digital copy attached to permit record, Permit# PW2007-035 <br /> E Saved to Address Folder in Development Tech File <br /> ❑NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> EYES-Type NFPA 13 <br /> ❑NOT REQUIRED <br /> Reason: SIZE AND USE OF BUILDING <br /> PUBLIC WORKS PEBm1T�00�5? <br /> EYES, Permit#PW PPWW2 <br /> X Stormwater NPDES Tab Completed in TRAKiT EADA Tab Completed in TRAKiT E Inspections Added in TRAKiT <br /> ❑NOT REQUIRED <br /> 2 <br /> Worksheet Completed By: .� �^�O Date: 05/05/ 021 <br /> Worksheet Checked By: 1ajfifl4.., y/JycnJ Date: 5/5/2021 <br /> REVISED 11/27/2019 <br />