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0 0 <br /> EVERETT <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON i f 000 <br /> PROJECT ADDRESS: 40t&RAILWAY AVE Permit#: B2108-075 <br /> TENANT: FORMA CONSTRUCTION <br /> DESCRIPTION OF WORK: BUILD 30X30 POLE BARN <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 ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size - 0 Per Cost Estimate <br /> ❑ Repair ❑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): ❑ RPBA or 0 DCVA <br /> SNOT REQUIRED I$rNOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑3 " Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA KNOT REQUIRED <br /> 'I NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Department) <br /> 0 Yes, Quantity , See attached for reference. <br /> RY 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 /> SNOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWA SYSTEM DVLME TRAFFIC MITIGATION FEES: <br /> / ❑YES, ❑SeeTER Attached for calculationsEEOP /creditENTF ES: 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW To be added on gain .-Q�'S ❑ See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 10S1 SF 0 NOT REQUIRED <br /> QTY is❑ Ground only 0 all hard surfaces QTY is XRoof only 0 all hard surfaces <br /> $ $ ..' <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: 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 evelopmerit Tech File <br /> 'NOT REQUIRED Silt- CO.�rrl l <br /> FIRE SPRINKLER S REQUIRED? <br /> ❑YES-Type <br /> }SNOT 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 Added in TRAKiT <br /> JP(NOT REQUIRED <br /> Worksheet Completed By: Date: <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />