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EVERETT <br /> 112 PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 419 ROCKEFELLER Permit#: PW2007-005 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITE WORK 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 /> New Connection to main plus ( connections to building .New Connection, Size 3/4 -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size - ❑ Per Cost Estimate <br /> ❑ Repair IeWater System Development Fee Total:$ 4,l 9D.oc� <br /> ❑ Cap-off, quantity 13r-Sewer System Development Fee Total: $.5,442,oc _ <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 � ❑ NOT REQUIRED �1 ��� <br /> Explanation/Utility Permit#: . -l 7J 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 ❑3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA 0 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 /> ❑Yes, Quantity , See attached for reference. <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 /> ❑ NOT 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 /> IXYES, Stormwater Total: $ 0 ZS. 5( XYES,Traffic Mitigation Total: $ 3, I47.00 <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) ❑ See Attached for calculations/credit <br /> PAll Hard Surface Fees to be added to Permit# P.r l?.00 1 - ooAr 0 NOT REQUIRED <br /> Rf-See Attached Spreadsheet for calculations/credit ��Q� <br /> ❑ NOT REQUIRED Lj -D01-'(�t <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: &SFR 0 DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> I .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# "a 20o-I-oo5 <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> OT REQUIRED <br /> eason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> f&YES, Pe mit#PW zc )1-c>OS <br /> Sr" oormwater NPDES Tab Completed in TRAKiT A DA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed B ���: Date: 01103 J�-d 77/ <br /> y <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />