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• • <br /> im EVERETT <br /> WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> immiPROJECT ADDRESS: 10721 19TH AVE SE UNIT A Permit#: C1802-019 <br /> TENANT: ZERZURA TOWNHOMES u G/ 6/_ 'CO <br /> DESCRIPTION OF WORK: NEW TOWNHOUSE BLDG 2 UNIT 4 1 / �(O <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 /> •NITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation& Cost Est.) ointiv <br /> gNew Connection to main plus I connections to building 0 New Connection, Size - 0 Per Cost Estimate ,3 <br /> ❑Alteration V'El Meter Only, Size/ ppn ir) - 0 Per Cost Estimate exs� <br /> ❑ Repair ✓ 15r Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity ✓ tiCSewer System Development Fee Total: $5,12/.02 -5121 Q5. <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIREDNOT REQUIRED -1_ <br /> Explanation/Utility Permit#: k xplanation/Utility Permit#: 401L1 Oftlifli\ _.-r ,e .9 ' <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size ❑3/4"Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention(Outside Building): 0 DCVA 1E1 NOT REQUIRED <br /> gNOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Depa m t) <br /> 12(Yes, Quantity 2 , See attached for reference. (Z)eonne fans f0►7 b.Ik on 19tb AVE,S semen i/ p 9 <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) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> 'KNOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: ,,,,-FRAFFIC MITIGATION FEES: <br /> EYES, Stormwater Total: $ 3,ly1.$3 ita <br /> ' YES,Traffic Mitigation Total: $ 24r.&-2 <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> la All Hard Surface Fees to be added to Permit# P01$02-030 0 NOT REQUIRED N 11)( tifflOME--EX S ' <br /> ❑ See Attached Spreadsheet for calculations/credit❑ NOT REQUIRED 40(A) Of 'r• <br /> In , <br /> Additional Checklists: - rti t_ <br /> ADDRESS LETTER REQUI ? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> (YES-TYPE: gl DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> Eit 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 /> M Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> x(YES-Type 13 p <br /> ❑ NOT REQUIRED <br /> Reason: ft 12a 0/3 <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> .YES, Permit#PW 1202-030 <br /> gStormwater NPDES Tab Completed in TRAKiT E(ADA Tab Completed in TRAKiT Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: -181111,' S ? <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />