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am EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1630 RUCKER AVE Permit#: B2105-003 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SFR REMODEL&RE-ROOF <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 ❑Meter Only, Size -❑ 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 /> ❑ ackwater Valve Vackflow Prevention (Outside Building): El RPBA or 0 DCVA <br /> NOT REQUIRED OT REQUIRED <br /> tl <br /> xplanation/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 ❑3/4' Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 packflow Prevention(Outside Building): 0 DCDA <br /> ❑ ackflow Prevention (Outside Building): El DCVA OT REQUIRED <br /> > OT REQUIRED Explanation/Utility Permit#: <br /> xplanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> ❑ NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Nackflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> OT 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 /> BYES, 0 See Attached for calculations/credit g /��� 0 YES,Traffic Mitigation Total:$ <br /> To be added on PW To be added on d C" 0 See Attached for calculations/credit <br /> Quantity charged SF Quantity c arged SF NOT REQUIRED <br /> QTY is 0 Ground only❑all hard surfaces QTY is WR.r only Ii all hard surfaces <br /> $ $ .. r <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 0 DUPLEX 0 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 /> N❑ ES—Type <br /> OT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> 0 Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections A ded in TRAKiT <br /> liNOT REQUIRED <br /> Worksheet Completed By: 37-1:b Date: 7 2-© ( <br /> Worksheet Checked By: 3 _ Date: (o Z <br /> REVISED 11/27/2019 <br />