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EVERETT <br /> 12WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 10721 19TH AVE SE UNIT B Permit#: C1802-020 <br /> TENANT: ZERZURA TOWNHOMES � <br /> DESCRIPTION OF WORK: NEW TOWNHOUSE BLDG 2 UNIT 5 aCgD 6 <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 - 0 Per Cost Estimate <br /> ❑Alteration EI Meter Only, Size I"WIM 0 Per Cost Estimate <br /> ❑ Repair IN Water System Development Fee Total: $ gASf. <br /> ❑ Cap-off, quantity El Sewer System Development Fee Total: $5; 24.t <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 REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA KNOT REQUIRED <br /> 'KNOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimatg request to Water Depa m nt) <br /> tit Yes, Quantity , See attached for reference.(Z.eonnu * "J fa nv-k glAvfr ar. I ls7Z <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): 0 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: TRAFFIC MITIGATION FEES: <br /> EYES, Stormwater Total: $ 3,I'I.%3 g YES,Traffic Mitigation Total: $ �' �, <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) ❑ See Attached for calculations/credit <br /> 'WAll Hard Surface Fees to be added to Permit#fti/1$02-O3D ❑ NOT REQUIRED N, 'J JNI` E <br /> ❑ See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists: -law N}1ani <br /> ADDRESS LETTER REQUI D? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> X'YES—TYPE: 18( ❑ DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> eit See Attached Letter, 2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> Q Digital copy attached to permit record, Permit# <br /> E(Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> B(YES—Type (g p <br /> ❑ NOT REQUIRED <br /> Reason: FAZE crppE <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> OYES, Permit#PW i$OZ—O3O <br /> Stormwater NPDES Tab Completed in TRAKiT DADA Tab Completed in TRAKiT $(Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />