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• <br /> EVERETT T <br /> PUBLIC WORKS REVIEW WORKSHEE <br /> m WASHINGTON <br /> PROJECT ADDRESS: 10312 EVERGREEN WAY Permit#: PW2104-011 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CLEARNING,GRADING, DRAINAGE, UTILITIES AND STREET IMPRVMNT <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 /> �Tlew Connection to main plus 3 connections to building A -New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair Pa" EFWater System Development Fee Total: $ <br /> ❑ Cap-off,quantity Et-Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub �' — £ - ❑Water Service Line(behind meter), Size <br /> ❑ Backwater Valve -- ig-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 /> ZI-New Connection, Size I ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3 " Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ _ ❑ Backflow Prevention(Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA s-NOT REQUIRED <br /> ❑ NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> 0Yes, Quantity .3 , See attached for reference. 2 - 6•9-041-0g.4..1.S I - 8',c 20 " r.,h-sca. c..,,4.4(j._-r...+ <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) 0 RPBA(for Domestic service) 0 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 /> , YES,4-See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW 21a4-O I‘ To be added on 0 See Attached for calculations/credit <br /> Quantity charged Go,341.oOSF Quantity charged SF $.NOT REQUIRED <br /> QTY is IIIGround only 0 all hard surfaces QTY is❑ Roof only 0 all hard surfaces <br /> $ 15,8 c4 . co.3 $ <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 /> ❑YES—TYPE: ❑ SFR ❑ DUPLEX ❑ADU 0 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 /> 0 Saved to Address Folder in Development Tech File <br /> ,NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> kNOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> -YES, Permit#PW 2 t0 4 -o 1 1 <br /> O3tormwater NPDES Tab Completed in TRAKiT I DA Tab Completed in TRAKiT %Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> s <br /> Worksheet Completed By;i �� Date: D1lZo 1 1 2-0 Z1 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />