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• <br /> im EVERETT <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 423 ROCKEFELLER AVE Permit#: PW2007-038 <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 /> &New Connection to main plus I connections to building -New Connection, Size 314 -❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair Ef;Water System Development Fee Total:$ 4, 190 ,00 <br /> ❑ Cap-off,quantity Sewer System Development Fee Total: $ 5,42 L.oo <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 1 ❑ NOT REQUIRED ` f Lc� <br /> Explanation/Utility Permit#: VI(1 V� D 3� Explanation/Utility Permit#: 1A '' O2A <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 "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 s--NOT REQUIRED <br /> E'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 /> ❑Yes, Quantity , See attached for reference. <br /> :lig-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 /> yl-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 /> TYES, Stormwater Total: $ I, o 2-4. Q AYES,Traffic Mitigation Total: $.3,(rn 00 <br /> o Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> EitAll Hard Surface Fees to be added to Permit# 1.7vn4 2001-03& 0 NOT REQUIRED <br /> EtSee Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED G 1-W1/O1,3) <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> DYES—TYPE: FR 0 DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> 0See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> I -Digital copy attached to permit record, Permit# 'Pvaioo1 - 03$ <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 /> PUBLIC WORKS PERMIT REQUIRED? <br /> di-YES, Permit#PW 20a't—03$ <br /> tormwater NPDES Tab Completed in TRAKiT CeADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> sr� ✓ <br /> Worksheet Completed By: Date: Cq/63/ 2, <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />