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EVERETT <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> Li WASHINGTON <br /> PROJECT ADDRESS: 3322 52ND PL SW Permit#: B2106-014 <br /> TENANT: LEROY&SU-HONG COONS <br /> DESCRIPTION OF WORK: CONVERT 990SF OF EXTG FINISHED BASEMENT TO ADU <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 0 New Connection, Size -❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ❑ Water System Development Fee Total: $ <br /> ❑ Cap-off,quantity 0,$ewer System Development Fee Total: $ <br /> ❑ Reconnection to stub ater Service Line(behind meter), Size <br /> Nackwater Valve Vet ackflow Prevention(Outside Building): 0 RP A or 0 DCVA <br /> OT REQUIRED 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: $ ❑ Qeckflow Prevention (Outside Building): 0 DCDA <br /> ❑packflow Prevention (Outside Building): 0 DCVA MOT REQUIRED <br /> id 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 /> J❑ es, Quantity , See attached for reference. <br /> IOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Vackflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> OT 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, 0 See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW To be added on / See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF q/IVOT REQUIRED <br /> QTY is 0 Ground only 0 all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ $ <br /> • NOT REQUIRED <br /> Additional Checklists: <br /> ApDRESS LETTER REQUIRED? (If yes (npw assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES—TYPE: 0 SFR 0 DUPLEX WADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> See Attached Letter,2 copies (Permit Techs to issue,,qnbcpy to a licant with permits, scan one copy to Jeffrey Marks) <br /> —pigital copy attached to permit record, Permit# .�O1 i <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 /> ❑YES, Permit#PW <br /> 0 Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> 1140NOT REQUIRED <br /> Worksheet Completed By: , Date: <br /> ,Z /20z <br /> Worksheet Checked By: Date: /212l ( Lc 2-1 <br /> REVISED 11/27/2019 <br />