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EVERETT <br /> w i <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> LI WASHINGTON <br /> PROJECT ADDRESS: 413 ROCKEFELLER AVE Permit#: PW2007-037 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITEWORK FOR NEW SFR <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 /> g-New Connection to main plus I connections to building 'New Connection, Size 311 -❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair ['Water System Development Fee Total:$ 4, l40 .00 <br /> ❑ Cap-off, quantity ,Sewer System Development Fee Total: $S,4 22, 0n <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): ❑ RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA aJ OT REQUIRED <br /> lid-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 /> ❑Yes, Quantity , See attached for reference. <br /> lel-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 /> RF- LOT 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, Stormwater Total: $ 1, o34. 7 3 OYES,Traffic Mitigation Total: $.3, Igloo <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> FAll Hard Surface Fees to be added to Permit# 1 i j 200-7• 3-1 0 NOT REQUIRED <br /> I See Attached Spreadsheet for calculations/credit <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 /> le-YES—TYPE: SFR ❑ DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> is See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> a-Digital copy attached to permit record, Permit# 9W 0L l <br /> 0-6aved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> kNOT REQUIRED <br /> Reason: <br /> ❑UBLIC WORKS PERMIT REQUIRED? <br /> CrYES, P rmit#PW ZOO?-0 3? <br /> -Stormwater NPDES Tab Completed in TRAKiT 1:66A Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: D 4!b 3 �ta Z <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />