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EVERETT PUBLI C WORKS REVIEW WORKSHEET <br /> in O S <br /> WASHINGTON <br /> PROJECT ADDRESS: 3618 SHORE AVE Permit#: C2010-002 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONSTRUCT NEW SFR WITH GARAGE <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Pemmi or Sewer, Water, Fire, and Irrigation, as selected below <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cos st.) <br /> 0 New Connection to mai • us 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,quantity 0 Sewer System Development Fee Total: $ <br /> *Reconnection to stub Water Service Line(behind meter), Size t " <br /> ❑ Backwater Valve 0 Backflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> NOT REQUIRED 0 NOT REQUIRED <br /> Ex lanation/Utility Permit#: A. _ — 5 Explanation/Utility Permit#: u kt( -OS\4 I. <br /> IRRIGATION SERVICE: (Not I luding Cost Estimates) FIRE SERVICE. Attach Cost Estimate/Request for Reference) <br /> ❑ New Connect' n, Size 0 New Conn tion, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, ize 0 3/4" Dete Meter Only, Service Size <br /> ❑Water Sy m Development Fee Total: $ 0 Backfl Prevention (Outside Building): 0 DCDA <br /> ❑ Backflo revention (Outside Building): 0 DCVA 13-NO EQUIRED <br /> NOT QUIRED Expl ation/Utility Permit#: <br /> Explan on/Utilit Permit#: <br /> WATER DEP TMENT COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qua ity , See attached for reference. <br /> 8-NOT R UIRED <br /> Plumbing P rmits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow P evention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> I-NOT RE IRED <br /> 7Suilding Permits (Not :Permit Technicia s dd all items selected below to associated Building Permit) <br /> TORMWATER SYSTEM VELOPMENT FE TRAFFIC MITIGATI FEES: <br /> 3 DYES, 01 See Attached f calculations/credi 3 ❑YES,Traffic Mit' ation Total: $ <br /> To be added on PW fit-d 51 o b added on G 2 0 ' 002 ❑ See Attac d for calculations/credit <br /> Quantity charged l't t S SF Quant y charged 137 SF II-NOT REQU ED <br /> QTY is 4-Ground ly❑ all hard surfaces QTY i Roof only all hard surfaces «.g�► Fob Fi s sr_ 5 ta.- <br /> $ S ,or $ tot5-• <br /> ❑ NOT REQUIRE <br /> Additional Chec fists: <br /> ADDRESS LETTER EQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ICES—TYPE: R 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY ❑ COMMERCIAL <br /> [BCSee ached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> Ir-Digit I copy attached to permit record, Permit# GZo'a- 001- <br /> Sa d to Address Folder in Development Tech File <br /> ❑ NOT REQ RED <br /> FIRE SPRINK RS REQUIRED? <br /> ❑YES—Typ <br /> NOT RE UIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> DYES, Permit#PW 2-i i r- C Sr <br /> Elr-Stormwater NPDES Tab Completed in TRAKiT I--ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: /Z?✓ Date: /l ( 2. I Z42 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />