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EVERETT W W <br />WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br />PROJECT ADDRESS: 3322 KROMER AVE Permit #: PW2104-014 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: DRAINAGE FOR NEW SFR AND RETAINING WALL <br />PW Reviewer to select all that apply below: <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water ee, and Irrigation, as selected below) <br />SA.NITARY SEW D E WATER SERVICE, (Atach Calculation & Cost Est.) <br />w Conn ion to main plus connections to building Connection, Size �I � - ❑ Per Cost Estimate <br />Alt atio Mete nly, Size - ❑ Per Cost Estimate <br />❑ Repa 6\� �e LA�V1 � Water S em Development Fee Total: $ H 311 <br />❑ Ca uantity 5 , `�9 Sewer Syste Development Fee Total: $ 155100, <br />ywew <br />❑ conne on to stub S 3�� DY1( ❑ Water Service Line (behind meter), Size <br />❑ ackwater Ive y ❑ Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />NOT REQUIRED .L/� ,c� � r'� � �� ❑NOT REQUIRED II �� Z� r_ r�l(D 2,L <br />Explanation/ Utility Permit #: �j b(Q �p I Elr,K�5 <br />ltUtility Permit #: V � "J o& ( <br />IRRIGATION SERVICE: (Not Including Cost Estimates) �� FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size ❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size ❑ %" Detect Meter Only, Service Size <br />❑ Water System Development Fee Total: $ ❑ Packflow Prevention (Outside Building): ❑ DCDA <br />❑ 5ackflow Prevention (Outside Building): ❑ DCVA OT REQUIRED <br />OT REQUIRED Xplianation/ Utility Permit #: <br />E planation/ Utility Permit #: <br />WA R DEPARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ s, Quantity , See attached for reference. <br />OT REQUIRED <br />7 <br />Plu bing Permits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />❑ ckflow Prevention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />OT REQUIRED <br />Building Permits (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />ST RMWATER SYSTEM DEVELOPMENT FEES: TR FIC MITIGATION FEES: 3 1 <br />44&ES, ❑ See Attached or cal ulatio s / credit Or-7jES, Traffic Mitigation Total: $ To be added on PW To be added on — ❑ See Attached for calculations / credit <br />Quantity charged SF Quantity cl prged SF ❑ NOT REQUIRED <br />QTY is ❑ Ground only II hard surfaces QTY is CWoof only 13 all hard surfaces <br />$ - $ <br />❑ NOT REQUIRED <br />Additional Checklists: <br />ADDRESS LETTE E UIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />IVES — TyPE: VFSFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />Orfiee Attached Letter, 2 copies (Permit Techs to i ue on oy to applicant with permits, scan one copy to Jeffrey Marks) <br />lWwg)igital copy attached to permit record, Permit # Z <br />aved to Address Folder in Development Tech He <br />❑ NOT R QUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type <br />CV40T REQUIRED <br />Reason: <br />PL16LIC WORKS PERMIT REQUIRED? <br />SVYES, VS,tormwat—er <br />it # PW <br />QRS' <br />abCorhpleted in TRAKiT */ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: Date: <br />Worksheet Checked By: � Date: C:>'t l 7 Zd2� <br />REVISED 1112712019 <br />