Laserfiche WebLink
EVERETT <br /> UlmWASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 1920 100TH ST SE Permit#: B2004-019 <br /> TENANT: SEA MAR COMMUNITY HEALTH CENTERS <br /> DESCRIPTION OF WORK: ADDITION BETWEEN EXISTING BUILDINGS A AND B <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 - 0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size - 0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off, qua tity 0 Sewer System evelopment Fee Total: $ <br /> ❑ Reconne 'on to stub 0 Water Se a Line(behind meter), Size <br /> • Backwa r Valve 0 Backflo revention (Outside Building): 0 RPBA or 0 DCVA <br /> ► IT QUIRED &NOT QUIRED <br /> Explan ion/Utility Permit#: Exp an tion/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connec'on, Size -0 Per Cost Estimate <br /> ❑ Meter 0 ly, Size 0 3 " Detect eter Only, Service Size <br /> ❑Water system Development Fee Total: $ Backflow revention (Outside Building): 0 DCDA <br /> ❑ Bac ow Prevention (Outside Building): 0 DCVA AC-NOT R UIRED <br /> NO REQUIRED Explana on/Utility Permit#: <br /> x. :nation/Utility Permit#: <br /> WATER DEP RTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qu tity , See attached for reference. <br /> firNOT R QUIR D <br /> Plumbin its (Note:Permit Technic: s to add all items selected below to Plumbing Permit-for items inside buil ing only) <br /> ■ :ack w revention (Inside Building): 0 DC A or Domestic service) 0 RPBA(for Domestic service) 0 DCDA(fo ' service) <br /> NOT R UIRED <br /> - <br /> Building Permits (Note:Permit Technicians to add all items selected below to ass ciated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> RYES Stormwater Total: $ 4 g• II ,YES,Traffic Mitigation Total: $4,9'?4-77 <br /> Roof Only Fee on Bldg Permit(ground hard -urfaces fee on PW Perrgi 0 See Attached for calculations/credit <br /> ❑All Hard Surface Fees to be added to Per t# ❑ NOT REQUIRED <br /> ❑ See Attached Spreadsheet for calculatio /cre ?f •C�k —CI❑ NOT REQUIRED � ' <br /> A ' 'onal Checklis • <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> fre-'i'ES—TYPE: 0 SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY COMMERCIAL <br /> a-See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> @f-Digital copy attached to permit record, Permit# -e Za 4 a 1-y <br /> lif-Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINK RS REQUIRED? <br /> ❑YES—Ty <br /> ji‘NOT R UIRED <br /> Reason: <br /> PUBLIC WORK ERMIT REQUIRED? <br /> ❑YES, Permi PW <br /> 0 ormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> JJOT QUIRED <br /> Work eet Completed By 0"--; i'' Date: D 4/2-6 Jw'?_o <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />