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1111 <br /> EVERETT <br /> WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 10723 19TH AVE SE UNIT A Permit#: C1803-018 <br /> TENANT: ZERZURA TOWNHOMES UI(}O1A- <br /> 09 <br /> DESCRIPTION OF WORK: NEW TOWNHOUSE BLDG 3 UNIT 12 ``"'I <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 /> ANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> New Connection to main plus 1 connections to building New Connection, Size - 0 Per Cost Estimate <br /> ❑Alteration Ai Meter Only, Size l''florn EKE-❑ Per Cost Estimate <br /> ❑ Repair ✓ Water System Development Fee Total: $ 3,9g7-.Q9 <br /> ❑ Cap-off, quantity t7131 Sewer System Development Fee Total: $5/I Z1 o-' <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: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA 'NOT REQUIRED <br /> KNOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimat request to Water Departme t) <br /> I 'Yes, Quantity a , See attached for reference. (1)corms * "f. moor 1° 'AYE on SC? S of on l 2�S ZZal9 <br /> ID 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 /> ''NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> ST/ORMWATER SYSTEM DEVELOPMENT FEES: tRAFFIC MITIGATION FEES: <br /> YES, Stormwater Total: $ 33IM I 4g3 AYES,Traffic Mitigation Total: $ R 001 <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> ''All Hard Surface Fees to be added to Permit# PW I$O2-030 ❑ NOT REQUIRED N-t 7Dii Jf OM6 <br /> ❑ See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists:,.rrravhe <br /> ADDRESS LETTER REQ RED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES—TYPE: E" 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ia'Digital copy attached to permit record, Permit# P14I/$02-'030 <br /> tif Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> AYES—Type 13 D <br /> ❑ NOT REQUIRED <br /> Reason: Fj Re cji <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> 'YES, Permit#PW I g0 2-030 <br /> Stormwater NPDES Tab Completed in TRAKiT Nt ADA Tab Completed in TRAKiT krinspections Added in TRAKiT <br /> ❑ NOT REQUIRED A <br /> Worksheet Completed By: r/ Date: 5 Z/ Z0/g <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />