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• <br /> EVERETT <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 7010 COLBY AVE Permit#: PW2006-035 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: 5 LOT SHORT PLAT PRIVATE ACCESS ROAD <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 /> liNew Connection to main plus I connections to building 0 New Connection, Size - 0 Per Cost Estimate <br /> ❑Alteration ❑ 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 /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED lik,NOT REQUIRED A1- -'- �•- 1 41 - gf_ c-AAA.14,:D <br /> Explanation/ Utility Permit#: Explanation/Utility Permit#: 11 if «-r> <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 0 3/4" Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA fi-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 /> 0-Yes, Quantity I , See attached for reference. g (,' -r,An -ro M�►-++�►. <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 /> KNOT 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, 11-See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW 2006- 03 S To be added on 0 See Attached for calculations/credit <br /> Quantity charged 5p44 SF Quantity charged SF .NIOT REQUIRED <br /> QTY is round only 0 all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ i,341. 5 $ <br /> ❑ NOT REQUIRED S o-to Pc...C55 ' FQe).4 r4(iC- $N�� <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 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 /> ❑ Saved to Address Folder in Development Tech File <br /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES-Type <br /> KNOT REQUIRED <br /> Reason: <br /> PhIJBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit# PW 2eX)(0 - o,3,S— <br /> t tormwater NPDES Tab Completed in TRAKiT DA Tab Completed in TRAKiT spections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By:, Date: C1(l3(2v 2.1 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />