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- • 11111 <br /> - EVERETT PUBLIC WORKS REVIEW W RK H E ET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3618 SHORE AVE Permit#: PW2011-016 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: Sitework for 2 Lot Short Plat <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 i connections to building New Connection, Size 1" co...,a -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost E timate <br /> ❑ Repair gWater System Development Fee Total:$ ,t 40.DO <br /> ❑ Cap-off, quantity El-Sewer System Development Fee Total: $5,4-1-Z-o 0 <br /> ❑ Reconnection to stub ❑Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED U <br /> �l t � O, C 0 NOT REQUIRED <br /> Explanation/Utility Permit#: ` `'�, Explanation/Utility Permit#:AA 2,1U 'akcA <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: ( ach Cost Estimate/Request for Reference) <br /> ❑ New Connecti , Size 0 New Conner' n, Size -0 Per Cost Estimate <br /> ❑ Meter Only, ize 0 3/4" Detect eter Only, Service Size <br /> ❑Water Sy em Development Fee Total: $ 0 Backflo Prevention (Outside Building): 0 DCDA <br /> ❑ Backflo Prevention (Outside Building): 0 DCVA Er-NOT EQUIRED <br /> SNOT EQUIRED Expl ation/Utility Permit#: <br /> Explanation/Utility Permit#: _ ._ <br /> WATER DEP RTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Q ntity , See attached for reference. <br /> lit-NOT QUIRED <br /> Plumbing ermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflo revention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> SNOT QUIRED <br /> uilding Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> /STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGA • FEES: <br /> el--YES, fe3�See Attached for calculations/credit 0 YES,Traffi f itigation Total: $ <br /> To be added on PW Zoit- o to To be added on 0 Se= •ttached for calculations/credit <br /> Quantity charged 8Vo SF Quantity charged SF INfNQO 'EQUIRED <br /> QTY is 0 Ground only 0 all hard surfaces QTY is 0 Roof only 0 all har surfaces <br /> $ 22(0•4i- <br /> OT REQUIRED $ <br /> Additional Checklists: <br /> ADDRESS LETTER QUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: FR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See tached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Di 'al copy attached to permit record, Permit# <br /> ❑ S ved to -•dress Folder in Development Tech File <br /> 15r-NOT RE UIR <br /> FIRE SPRIN ERS REQUIRED? <br /> ❑YES—Ty,- <br /> 111-NOT R:QUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> pl YES, Permit#PW Zo El- Di to <br /> [>-Stormwater NPDES Tab Completed in TRAKiT iff-ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By:."- ------ i- Date: I% t 2.3 I ze'u <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />