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EVERETT <br /> lialWASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 2503 WETMORE AVE Permit#: C1808-011 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: BUILD NEW DUPLEX ON REAR OF LOT <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: (A t Y�00(p DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> I, 'New Connection to main plus I connections to building New Connection, Size I 'foi►tc� Per Cost Estimate <br /> ❑Alteration / ❑Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair Q '( i l Water System Development Fee Total: $ 3,9 S 4,oC X t <br /> ❑ Cap-off, quantity u1Q0?�004: � . Sewer System Development Fee Total: $ /l j,0 b \f'L <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve IA t 4 07-0'0= 5 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED . aExplanation/Utility Permit#: Explanation/Utility Permit#: UrirF 11' it 0 n.i- 6 Earik- <br /> 1 <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/" 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 IrNOT REQUIRED <br /> 4NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> 171 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 /> ga NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> ATORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> '" Id'YES, Stormwater Total: $ 0"ZZ • Uv Et YES,Traffic Mitigation Total: $ 1-j BOO <br /> 0 Roof Only Fee on Bldg Permit(ground hard surfac fee on PW Permit) 0 See Attached for calculatio /credit <br /> pi All Hard Surface Fees to be added to Permit# — 0 NOT REQUIRED No <br /> L3 See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> Agi YES—TYPE: 0 SFR Qd"DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> Nr See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> tyi Digital copy attached to permit record, Permit# P'(J l'917 q <br /> 0 Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> OT R46� IR <br /> 'tCeaon: V wE 0.1 6 i3D $ it VOA CA ( ( �� IFIRe 'afi 180 tilerreACS. <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> I 'YES, Permit#PW / c O E -ozct r <br /> iiit Stormwater NPDES Tab Completed in TRAKiT xi ADA Tab Completed in TRAKiT pInspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: — - Date: D 6 ? Z`' <br /> v <br /> Worksheet Checked By: Date: 201 <br /> f. <br /> REVISED 4/24/2019 <br />