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EVERETT <br />WASHINGTON <br />PROJECT ADDRESS: <br />TENANT: <br />DESCRIPTION OF WORK: <br />PUBLIC WORKS REVIEW WORKSHEET <br />10312 EVERGREEN WAY <br />Permit #: PW2104-011 <br />[TenName] <br />CLEARNING, GRADING, DRAINAGE, UTILITIES AND STREET IMPRVMNT <br />)Plnw. 11�k OU *-- <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br />SANITARY SEWER: <br />ew Connection to main plus 3 connections to building <br />❑ Alteration <br />❑ Repair <br />❑ Cap -off, quantity <br />❑ Reconnection to stub <br />❑ Backwater Valve <br />❑ NOT REQUIRED <br />Explanation/ Utility Permit #: _ <br />IRRIGATION SERVICE: (Not Including Cost Estimates) <br />O-New Connection, Size <br />❑ Meter Only, Size <br />❑ Water System Development Fee Total: $ <br />❑ Backflow Prevention (Outside Building): ❑ DCVA <br />❑ NOT REQUIRED <br />Explanation/ Utility Permit #: <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />AD -New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size - ❑ Per Cost Estimate <br />RI -Water System Development Fee Total: $ <br />I'Sewer System Development Fee Total: $ <br />❑ Water Service Line (behind meter), Size <br />O Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />❑ NOT REQUIRED <br />Explanation/ Utility Permit #: <br />FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ %" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building): ❑ DCDA <br />AtNOT REQUIRED <br />Explanation/ Utility Permit #: <br />UER DEPARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />Yes, Quantity 3 , See attached for reference. Z - �•wEN 4.�* 3 t - 8' -� 2c " wA-C40- c..,�.+F�c�r•.«+ <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): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ 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: <br />jf-YES, OC�6ee Attached for calculations / credit <br />To be added on PW 1104.0 It To be added on <br />Quantity charged Go, 3b?. o6SF Quantity charged SF <br />QTY is 1K Ground only ❑ all hard surfaces QTY is ❑ Roof only ❑ all hard surfaces <br />$ 15, 6R4. (03 $ <br />❑ NOT REQUIRED <br />TRAFFIC MITIGATION FEES: <br />❑ YES, Traffic Mitigation Total: $ <br />❑ See Attached for calculations / credit <br />KNOT 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 />,ANOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type <br />NOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />ES, Permit # PW /o 4 -ol 1 <br />^ormwater NPDES Tab Completed in TRAKiT 11(*DA Tab Completed in TRAKiT fllInspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By Date: 0'712013-02.1I <br />Worksheet Checked By: Date: <br />REVISED 11/27)2019 <br />