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• 0 <br /> EVERETT WORKSHEET PUBLIC WORKS REVIEWHEET O S <br /> laWASHINGTON <br /> PROJECT ADDRESS: 2216 127TH PL SE Permit#: K2204-005 <br /> TENANT: ADULT FAMILY HOME <br /> DESCRIPTION OF WORK: NEW FIRE SPRINKLER SYSTEM IN AN EXTG ADULT FAMILY HOME <br /> PW Reviewer to select all that apply below: Uf 22_0(40 <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit f r Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation& Cost Est\ <br /> ❑ New Conneetion to main plus connections to building ligNew Connection, Size I " -orPer 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 0 Water Service Line(behind meter), Size <br /> BTwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCV <br /> 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 R ference) <br /> ❑ New Connection, Size �N; flew Conne tion, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Deter Meter Only, Service Size <br /> ❑Water S tem Development Fee Total: $ 0 Bac ow Prevention (Outside Building): 0 DCDA <br /> ❑ Backfl Prevention (Outside Building): 0 DCVA �J REQUIRED <br /> i�AIOT EQUIRED E lanation/Utility Permit#: <br /> e0:A3,K <br /> Expla tion/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> ❑ NOT REQUIRED <br /> lumbing'Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> (13 <br /> Back w Prevention (Inside Building): DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> ❑ N REQUIRED kA2-2-0q —co3 <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, 0 See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW To be added on 0 See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF 0 NOT REQUIRED <br /> QTY is ❑Ground only 0 all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ $ <br /> WV REQUIRED <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: 0 SFR 0 DUPLEX 0 ADU ❑ 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 /> IIOT QUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> EYES-Type �3- o <br /> ❑ NOT REQUIRED <br /> Reason: A L%N <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit# <br /> ,PW <br /> ❑ St water NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> IX-NOT RE IRED <br /> Worksh t Completed By: Date: 513 / ' ' <br /> Z' <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />