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EVERETT <br /> IraWASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 8015 BROADWAY Permit#: PW2204-018 <br /> TENANT: CHICKALATTE BEAUTIFUL COFFEE LLC <br /> DESCRIPTION OF WORK: REPLACE EXISTING COFFEE STAND WITH A NEWER ONE <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 -❑ Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ❑ Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity ❑ Sewer System Development Fee Total: $ <br /> Reconnection to stub ❑ Water Service Line(behind meter), Size <br /> Backwater Valve ❑ Backflow Prevention(Outside Building): ❑RPBA ❑ DCVA <br /> ❑ NOT REQUIRED UFO 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 -❑ Per Cost Estimate <br /> ❑ Meter Only, Size ❑ 3/4" Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building): ❑DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑DCVA ® NOT REQUIRED <br /> ®'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 /> Di Yes, Quantity , See attached for reference. <br /> iggi NOT REQUIRED <br /> Plumbing Permits(Note:Permit Technicians to add all items selected below toPlum in Permit-for items <br /> erns inside building only)) <br /> Backflow Prevention (Inside Building): ❑DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> [1r}�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, ❑ See Attached for calculations/credit ❑YES,Traffic Mitigation Total: $ <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❑ Ground only❑ all surfaces QTY is❑ Roof only❑all surfaces <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: ❑ SFR ❑ 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# <br /> ❑ Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> 01 YES—Type <br /> flig NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> EYES, Permit#PW Z2o4-Dili <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: ' Date: (o /3/1tJ2, <br /> Worksheet Completed By: Date: <br /> REVISED 12/22/2021 <br />