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EVERETT In <br /> WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 10749 19TH AVE SE UNIT/C, Permit#: C1803-020 <br /> TENANT: ZERZURA TOWNHOMES t p'Ia0 /r <br /> DESCRIPTION OF WORK: NEW TOWNHOUSE BLDG 3 UNIT 10 �l I !1 <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 � 0 New Connection, Size - 0 Per Cost Estimate <br /> ❑Alteration 1r Meter Only, Size I trtilr,r 0 Per Cost Estimate <br /> ❑ Repair V 3 Water System Development Fee Total: $ 3f 951. <br /> ❑ Cap-off, quantity /lEt Sewer System Development Fee Total: $5/ /21. <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ 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 Review r to s nd cost estimat request to Water Depart n <br /> 'Yes, Quantity a , See attached for reference. Cep 1eC 1 Moll M 19f SE St it o' l 2041 <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) ❑ DCDA(for Fire service) <br /> 1KNOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: AFFIC MITIGATION FEES: <br /> '' ot <br /> � Traffic <br /> YES, Stormwater Total: $ '�'t.S3 EYES, Mitigation Total: $ Auv.--- <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# Wing-050 ❑ NOT REQUIRED /49 mtjoibinE <br /> ❑ See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists• Om£ <br /> ADDRESS LETTER REQ ED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES-TYPE: 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> 12tSee 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 /> ' Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> /IRE SPRINKLERS REQUIRED? <br /> YES-Type 15 P <br /> ❑ NOT REQUIRED <br /> Reason: F R_E CODE <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> EYES, Permit#PW($o -OaQ �/ <br /> Stormwater NPDES Tab ompleted in TRAKiT 'ADA Tab Completed in TRAKiT (.Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED ' - <br /> WorksheetCompletedB : IIs y Date: ZI 2 Iq <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />