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EVERETT <br /> s • <br /> IZ WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 8907 5TH AVE W Permit#: PW2204-017 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITEWORK FOR NEW SFR <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Uti h e t 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 : '` -❑ Per Cost Estimate <br /> ❑ Alteration L Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair Water System Development Fee Total:$ 7, 200.00 <br /> ❑ Cap-off,quantity f Sewer System Development Fee Total: $c13 t 8 .00 <br /> NI Reconnection to stub ❑ Water Service Line(behind meter), Size <br /> III :ackwater Valve ❑ Backflow Prevention(Outside Building): ❑RPBA ❑ CVA <br /> ❑ NOT REQUIRED !� �, p ❑ NOT REQUIRED ( 1 Q� c e <br /> Explanation/Utility Permit# l/� . .-0-4 Explanation/Utility Permit# U. (� �lri <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Co ection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size ❑ 3/4" De ct Meter Only, Service Size <br /> ❑ Water ystem Development Fee Total: $ ❑ Ba ow Prevention(Outside Building): ❑DCDA <br /> ❑ Ba ow Prevention(Outside Building): ❑DCVA jg T REQUIRED <br /> • N T REQUIRED xplanation/Utility Permit# <br /> xplanation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> [V 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 /> 141 NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selecte. . - , to asso•dted Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT EES: FFIC MITIGATION FEES: <br /> [ .YES, (yg See Attached for calculations/credit IN-YES,Traffic Mitigation Total: $3,4 q 4.06 <br /> To be added on PWZ Z-a 4'o1't To be added on132- o4- o 4 3 <br /> ❑See Attached for calculations/credit <br /> Quantity charged23l�SF Quantity charged i13vSF ❑ NOT REQUIRED <br /> QTY is[l .Ground only❑ all surfac 9TY is[l�Roof only❑ all s - <br /> $�3co. z9 4co4 .90 <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> I: YES-TYPE: I -SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ® Digital copy attached to permit record, Permit# z20 4-o 4 3 <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRE <br /> FIRE SPRIN RS REQUIRED? <br /> ❑ YES-T e <br /> t. <br /> NOT QUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> [BYES, Permit#PW 21-404-o ( ' <br /> EStormwater NPDES Tab Completed in TRAKiT uTADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: E Date: d$ /2.-s 1- <br /> Worksheet Completed By: Date: <br /> REVISED 12/22/2021 <br />