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• • <br /> - EVERETT <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> NM WASHINGTON <br /> PROJECT ADDRESS: 2007 CEDAR ST Permit#: B2106-016 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADDITION TO EXTG HOME <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 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size - 0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off,q ntity 0 Sewer Sys m Development Fee Total:$ <br /> ❑ Reconn tion to stub 0 Water S ice Line(behind meter), Size <br /> Mckw er Valve ❑ ckfl Prevention(Outside Building): ❑RPBA or❑ DCVA <br /> EQUIRED l O EQUIRED <br /> Expi ation/Utility Permit#: Expl ation/Utility Permit#: <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"Dete t Meter Only, Service Size <br /> ❑Water Sys m Development Fee Total:$ flack w Prevention (Outside Building): 0 DCDA <br /> o yackflow revention (Outside Building): 0 DCVA O EQUIRED <br /> OT R QUIRED Expl ation/Utility Permit#: <br /> Explana on/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qu tity , See attached for reference. <br /> V NOT R UIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Vackflow revention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(f rpomestic service) 0 DCDA(for Fire service) <br /> OT RE UIRED <br /> Building Permits (Note:Permit Technicians to add all items selected be o associated Building Permit) <br /> S1ORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGAT N FEES: <br /> YES, 0 See Attache r c Iculatio s/credit �,f ❑YES,Traffic •igation Total: $ <br /> To be added on PW To be added on D�'1diLifil.., See Att• hed for calculations/credit <br /> Quantity charged SF Quantity c arged 1SF G IOT REP IRED <br /> QTY is 0 Ground a h rd surfaces QTY is litRoof only 0 aik surfaces <br /> $ <br /> ❑ NOT REQUII'�tu 5 1,15 o d G� <br /> .(g <br /> ditionhecklists: <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 /> 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 /> /See <br /> Saved to Address Folder in Development Tech File <br /> NOQUIRED <br /> FIRE SP KLERS REQUIRED? <br /> 7/N <br /> ❑ ES ype <br /> O REQUIRED <br /> eason: <br /> WPU LIC WORKS PERMIT QUIRED? <br /> ES, Per it#PW <br /> I 'Stormwater PD S Tab Completed in TR KiT IJDA Tab Completed in TRAKiT 0 Inspections dded in TRAKiT <br /> NOT REQUIRED <br /> Worksheet Completed By: TSj Date: 0 <br /> Worksheet Checked By: v _ Date: r' ` Cp i ZO L <br /> I <br /> REVISED 11/27/2019 <br />