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0 • <br /> ii__. EVERETT <br /> WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 2309 CALIFORNIA AVE Permit#: B2207-045 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADDN OF DADU FROM ALLEY <br /> PW Reviewer to select all that apply below: <br /> tility Permits (Note:Permit Technicians to Crea tility Permit f ewer, Water, Fire, and Irrigation, as selected below) <br /> ANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation& Cost Est.) <br /> ❑ New Connection to main plus connections to buildin CI Connection, Size -❑ Per Cost Estimate <br /> Ni <br /> Alteration ❑ Meter Only, Size -❑ Per Cost Estimate <br /> El Repair ❑ Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity ❑ Sewer System Development Fee Total:$ <br /> ❑ Reconnection to stub 131 Water Service Line(behind meter), Size y <br /> ❑ Backwater Valve CI Backflow Prevention(Outside Building): ❑RPBA CIA <br /> NOT REQUIRED O�Q NOT REQUIRED f� <br /> Explanation/Utility Permit# � D Explanation/Utility Permit# V�. t —03q <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Co,nection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size El 3/4" D- ect Meter Only, Service Size <br /> ❑ W er System Development Fee Total: $ ❑ :, kflow Prevention(Outside Building): ❑DCDA <br /> ❑ ackflow Prevention (Outside Building): ❑DCVA <br /> NOT REQUIRED <br /> f` OT REQUIRED <br /> Explanation/Utility Permit# <br /> Explanation/Utility Permit# <br /> WATER D ARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes uantity , See attached for reference. <br /> [ T REQUIRED <br /> limb" • Permits(Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Backfl., Prevention(Inside Building): ❑DCVA (for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> C2 ► •T REQUIRED <br /> =uilding Permits (Note:Permit Technicians to add all items selecte ow to a sociated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT S: TRAFFIC MI ATION FEES: <br /> IN YES, ❑ See Attache for calcul ons credit ❑YES,T ffic Mitigation Total: $ <br /> To be added on PW _�1—01 To be added on-F.2Zo'l py c See Attached for calculations/credit <br /> Quantity charged' F 7 tit CI Quantity charged 010 SF IX N REQUIRED <br /> QTY is[;;J'Ground only❑ all surface; QTY is jftof only❑ all surface <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 />, §4 YES—TYPE: El SFR ❑ DUPLEX [J ADU CI INFILL DWELLING ❑ MULTI-FAMILY CI COMMERCIAL <br /> E.See Attached Letter,2 copies(Permit Techs to issue one o to a licant with permits, scan one copyto Jeffrey <br /> p P P Marks) <br /> Digital copy attached to permit record, Permit# 32 _0 L 'U4 5 <br /> [''Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> a NOT REQUIRED <br /> eason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW 2201-O i S <br /> �.Stormwater NPDES Tab Completed in TRAKiT [4ADA Tab Completed in TRAKiT El Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: r)bit f(22zv <br /> Worksheet Completed By: r---- - Date: 7/9 1 /20 Z Z <br /> REVISED 12/22/2021 <br />