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• • <br /> EVERETT WORKSHEET 112 PUBLIC WORKS REVIEWO SHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 9 77TH PL SW Permit#: B2009-045 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADU -615 SF UN1 <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 0 New Connection, Size -0 Per Cost Estimate <br /> Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off,quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub Water Service Line(behind meter), Size 3/4" <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: $ ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> Backflow Prevention (Outside Building): ElDCVA fiOT REQUIRED <br /> NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> ft<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 /> igNOT 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 /> RYES, Stormwater Total: $ 132►0 4 0 YES,Traffic Mitigation Total: $ <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# NOT REQUIRED <br /> 1ZINSee Attached Spreadsheet for calculations/crgdit <br /> ❑ NOT REQUIRED p20ol, ,,orf <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES—TYPE: ❑ SFR ❑ DUPLEXADU ❑ 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 /> ❑ Digital copy attached to permit record, Permit# <br /> ❑ Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> NOT REQUIRED <br /> Reason: <br /> PJBLIC WORKS PERMIT REQUIRED? <br /> YES, emit#PW '2A lD —0�'' <br /> Stormwater NPDES Tab Completed in TRAKiT I6DA Tab Completed in TRAKiT 06nspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: ^^�"‘A Date: to/42 I 20 <br /> Worksheet Checked By: AtA Date: 1 O J Z ZOZO <br /> REVISED 11/27/2019 <br />