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0 <br /> EL. EVERETT <br /> WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> MEIPROJECT ADDRESS: 10725 19TH AVE SE UNIT A Permit#: C1803-021 <br /> TENANT: ZERZURA TOWNHOMES n / (q^'^ Of g <br /> DESCRIPTION OF WORK: NEW TOWNHOUSE BLDG 4 UNIT 9 Y/L tJ W <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.) <br /> i New Connection to main plus I connections to building v❑ New Connection, Size - 0 Per Cost Estimate <br /> ❑Alteration Meter Only, Size room VIRG-0 Per Cost Estimate <br /> ❑ Repair V.: Water System Development Fee Total: $ 3,9 ;°O <br /> ❑ Cap-off, quantity / Sewer System Development Fee Total: $5,12.1."-; <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): ❑ DCVA SNOT REQUIRED <br /> NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMEN COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Depart en) <br /> ' (Yes, Quantity , See attached for reference. (a) + � c fS 'I� ,ri,4, c n I9t s6, s n" On iizs''�l°I <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) ❑ RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> '.NOT 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 /> 'R(YES, Stormwater Total: $ 3,IL 1.$3 grYES,Traffic Mitigation Total: $ 0/004 <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# PWI802-030 0 NOT REQUIRED NUJ 70Igniliame <br /> ❑ See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists• >Ug06 <br /> %A DRESS LETTER REQU ED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES-TYPE: IB;SFR-"0 DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> gSee Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> gDigital copy attached to permit record, Permit# <br /> 'Saved to Address Folder in Development Tech File <br /> /❑ NOT REQUIRED <br /> ✓ FIRE SPRINKLERS REQUIRED? <br /> 'Rl'YES-Type 159 <br /> ❑ NOT REQUIRED <br /> Reason: nth O2 <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> Z.YES, Permit#PW $Oc?-030 <br /> 'Stormwater NPDES Tab Completed in TRAKiT $'CADA Tab Completed in TRAKiT AlInspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> livt <br /> Worksheet Completed By: J Date: 5 °?/ ZO/C7 <br /> Worksheet Checked By: Date: <br /> REVISED 4/24/2019 <br />