2119 LOMBARD AVE 2023-05-30 - Laserfiche WebLink

im EVERETT WASHINGTON PUBLIC WORKS REVIEW WORKSHEET PROJECT ADDRESS: 2119 LOMBARD AVE Permit#: B2103-087 TENANT: YOUNGBLUT KASIDEE DESCRIPTION OF WORK: NEW DADU THAT IS TWO STORIES PW Reviewer to select all that apply below: Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation& Cost Est.) ❑ ew Connection to main plus connections to building 0 New Connection, Size -0 Per Cost Estimate il Alteration 0 Meter Only, Size - 0 Per Cost Estimate Repair ❑ Water System Development Fee Total:$ ❑ Cap-off,quantity 1,fewer System Development Fee Total: $ ❑ Reconnection to stub MNVater Service Line(behind meter), Size ❑ Backwater Valve 0 Backflow Prevention (Outside Building): ❑ B or 0 DCVA ❑ NOT REQUIRED 0 NOT REQUIRED Explanation/Utility Permit#: Explanation/Utility Permit#: IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) ❑ New Connection, Size ❑ New Connection, Size -0 Per Cost Estimate ❑ Meter Only, Size ❑3/4" Detect Meter Only, Service Size ❑Water System Development Fee Total:$ 0ackflow Prevention(Outside Building): 0 DCDA ❑ ackflow Prevention (Outside Building): 0 DCVA OT REQUIRED CI REQUIRED Explanation/Utility Permit#: xplanation/Utility Permit#: WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) ❑ es, Quantity , See attached for reference. JOT REQUIRED Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) NVI(NOT REQUIRED Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) STpRMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: ES, 0 See Attache f r alculati s/credit ❑YES,Traffic Mitigation Total: $ To be added on PW — To be added on L. — �1 ❑ See Attached for calculations/credit Quantity charged SF Quantity c arged SF IIVNOT REQUIRED QTY is Cl Ground only all hard surfaces QTY is WRoof onl a I rd surfaces ❑ NOT REQUIRED%'Z7 $ Additional Checklists: itADRESS LETTER REQUIRED? (If yes ( w assigned address), print out Address Letter from TRAKiT Print Menu and include) LES—T PE: 0 SFR 0 DUPLEX VADU 0 INFILL DWELLING CI MULTI-FAMILY 0 COMMERCIAL Wee Attached Letter,2 copies (Permit Techs to issue one cop pplicant with permits, scan one copy to Jeffrey Marks) V igital copy attached to permit record, Permit# $2163- Saved to Address Folder in Development Tech File ❑ NOT R QUIRED FIRE SPRINKLERS REQUIRED? ❑YES—Type IDIOT REQUIRED Reason: PUJBLIC WORKS PERMIT REQUIRED? ES, P rmit#PW tormwater DE Tab ompleted in TRAKiT 1ADA Tab Completed in TRAKiT 0 Ins ctions dded in TRAKiT ❑ NOT R QUIRED /� �1 Worksheet Completed By: Date: ©� v �vZ� Worksheet Checked By: 111- -------:"..-7 �� `• Date: /'r (s l Zvz�Z— REVISED 11/27/2019