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- III • <br /> - E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3506 ROCKEFELLER AVE Permit#: B2208-023 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADD KITCHEN AND CONVERT FINISHED BASEMENT TO ADU <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 connections to building ❑ New Connection, Size -❑ Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ❑ Water System Development Fee Total: $ <br /> ❑ Cap-off, •iantity ❑ Sewer System Development Fee Total:$ <br /> ❑ Recon.-ction to stub ❑ Water S:.rvice Line(behind meter), Size <br /> ❑ Bac. ater Valve ❑ Bac ;•w Prevention (Outside Building): ❑RPBA ❑ DCVA <br /> t3Nc REQUIRED fa Ne REQUIRED <br /> Ex. .nation/Utility Permit# Ex. .nation/Utility Permit# <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Connection, Size -❑ Per Cost Estimate <br /> • Meter Only,Size ❑ %" etect-Meter Only, Service Size <br /> ❑ Water System Development Fee Total:$ ❑ ckflow Prevention (Outside Building): ❑DCDA <br /> ❑ Bac ow Prevention(Outside Building): ❑DCVA tz OT REQUIRED <br /> z N REQUIRED Explanation/Utility Permit# <br /> xplanation/Utility Permit# <br /> WATER DEP RTMENT COST ESTIMATE NEEDED-(/f yes, PWReviewerto send cost estimate request to Water Department) <br /> ❑ Yes, Q ntity ,See attached for reference. <br /> p NOT EQUIRED <br /> Plu bing ermits(Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Backflow Pr ention(Inside Building): ❑DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> ❑ NOT QUIRED <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 /> ❑ YES, ❑ See Attached for calculations/credit ❑YES,Traffi itigation Total: $ <br /> To be added on PW To be added on ❑ e Attached for calculations/credit <br /> Quantity cha ed SF Quantity charged SF fig NO EQUIRED <br /> QTY is round only❑ all surfaces QTY is❑ Roof only❑ all surfaces <br /> OT EQUIRED �,Q jY)kV\ ►�i l f�Y1d� I(�, ,�y or�,a <br /> Addi Tonal Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> 7 <br /> g YES—TYPE: ❑ SFR ❑ DUPLEX El ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> Iii 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# 2743^o2 3 <br /> El.Saved to Address Folder in Development Tech File <br /> NOT REQUIRED <br /> FIRE PRIN RS REQUIRED? <br /> ❑ YES—T e <br /> ®'NOT QUIRED <br /> Reason: <br /> PUBLIC WORK ERMIT REQUIRED? 0 <br /> ❑ YES, Perm' #PW <br /> ❑ Stor ater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> rszi NOT R QUIRED <br /> Worksheet Completed By:A Date: D 110 LZ / <br /> Worksheet Completed By: Date: o b6l'Za'�z- <br /> REVISED 12/22/2021 <br />