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AML <br />EVERETT <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 10312 EVERGREEN WAY Permit M PW2104-011 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: CLEARNING, GRADING, DRAINAGE, ILIe2A O coES AND STREET IMPRVMNT <br />� <br />PW Reviewer to select all that apply below: <br />Q <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Se r, Water, Fire, and Irrigation, as selected below) <br />SANITARY SEWER: DOMESTI TER SERVICE: (Attach Calculation &Cost Est.) <br />ew Connection to main plus 3 connections to building flew Connection, Size '-" - ❑ Per Cost Estimate <br />❑ Alteration ❑ Meter Only, Size - ❑ Per Cost Estimate <br />❑ Repair JN-Water System Development Fee Total: $ <br />❑ Cap -off, quantity S£ .M`Sewer System Development Fee Total: $ <br />❑ Reconnection to stub ❑ Water Service Line (behind meter), Size <br />❑ Backwater Valve O-Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />❑ NOT REQUIRED I' ❑ NOT REQUIRED <br />Explanation/ Utility Permit #: ZZvI OZ01 Explanation/ Utility Permit* <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate /Request for Reference) <br />"ew Connection, Size I ❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size ❑ %" Detect Meter Only, Service Size <br />❑ Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): ❑ DCDA <br />❑ Backflow Prevention (Outside Building): ❑ DCVA I�NOT REQUIRED <br />❑ NOT REQUIRED 0 2 Explanation/ Utility Permit #: <br />Explanation/ Utility Permit #: U 2 2 <br />WYTER DEPARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />Yes, Quantity 3 , See attached for reference. Z WA-aca- c.,r..6CCO-.«4 <br />NOT REQUIRED <br />Plumbing 1 ( rmit Technicians to a selected below to Plumbing Permit -for items inside building only) <br />❑ Backflow Prevention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />❑ NOT REQUIRED C i A C I t� W J ZZp l— 0"ZI / <br />Uilding Permits (Note: Permit Technicians to items selected below to associated Building P it) <br />STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MI ATION FEES: <br />JtYES, See Attached for calculations / credit ❑ YES, Tr is Mitigation Total: $ <br />To be added on PW 1104 -e I t To be added on ❑ Sp6 Attached for calculations / credit <br />Quantity charged Go, 3b?. o6SF Quantity charged SF pb REQUIRED <br />QTY is K Ground only ❑ all hard surfaces QTY is ❑ Roof only all hard surfaces <br />$ 15, 6 R 4 . (03 $ <br />OT 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 ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ 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 />tNOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type <br />kNOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED.? <br />ES, Permit # PW to 4 -011 <br />O-Stormwater NPDES Tab Completed in TRAKiT 25r*flA Tab Completed in TRAKiT inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By Date: o'? j2o 1210 Z/ <br />Worksheet Checked By: Date: <br />KtVIJtU 77r1//LU79 <br />