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`EVERETT PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 192E VIRGINIA AVE Permit#: PW2207�019 <br />TENANT: [TenName) <br />DESCRIPTION OF WORK: REPLACE SIDEWALK IN FRONT OF SFR <br />PWRevlewerm seloctae Mercator below.' <br />Utility Permits (Nola: Farm# Technicians to Create Lately Pemsr low Serer, Water, Fire, and Imgafion, as selected belo 1 <br />SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation & CostEst.) <br />❑ New Connection to main plus_ connections to building ❑New Connection, Size Per Cast Estimate <br />Alteration ❑ Meter Only, Size - Per Cost Estimate <br />[] Repair ❑ Water System Development Fee Trial: $_ <br />Cap -off, quantity _ ❑ Sewer System Deyelopmenl Fee Total: $_ <br />Reconnection to stub ❑ Water Service Une (behin l meter). Size <br />El Backwater Valve ❑ Backfire, Prevention (Outside Building): []RPBA [] DCVA <br />E4 NOT REQUIRED ® NOT REQUIRED <br />Explanation/Utility Peunil# _ ExplanatioNUtility Permit #_ <br />IRRIGATION SERVICE.(Nothrdud)ng Cast Estimates) FIRE SERVICE:(Agech Cost Esttmale/Requesa for Reference) <br />Naw Connecion. Sae New Connection, Size - [] Per Cost Estimate <br />_ <br />Meter Only, Size _ ❑ Y.' Deted Meter Only, Service Size _ <br />❑ Water System Development Fee Toml: E_ ❑ Backfow Prevention (Outside Building): []DCOA <br />❑ Backfire, Prevention (Outside Building): []DCVA ® NOT REQUIRED <br />® NOT REQUIRED Explanation/Ulility Permit# <br />ExplanationsNlity Permit #_ <br />WATER DEPARTMENT COST ESTIMATE NEEDED -If yes, PW Revlewerto mail cost muimefe request to Wafer Department) <br />Yes, Quantity _, Sea attached for reference. <br />NOT REQUIRED <br />Plumbing Permits (Note: None Teebrovans to add aq items selected below b Plumbing Pemet-for#ems inside building Amy) <br />Backfoke Preverdion(Inside Building): []DQVA (tor Oomealic service) []RPBAtImDmresticservlce) []OCDA (/orFlre servce) <br />NOT REQUIRED <br />Building Permits (Nara: Permit Techiscurs; to add al/fems selected belowao dominated <br />Budding PenMQ <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />RAFFIC MITIGATION FEES: <br />YES, Sae Algdretl for calculations lcredit <br />VES,Trelfic Mitigation ToMl:$_ <br />Tobeaddedon PWti T-plq To be added on <br />[]See Attained for cakulafons/credit <br />Quantity charged SOD SF QuaMitycharged_SF <br />NOT REQUIRED <br />CRY is Ground only [I all surfaces pry Is El Roof onty [I all surfaces <br />[] NOT REQ IRED <br />Additional Checklists: <br />OD LETTER RE UIRED? (Ifyes(nawassuguedaddreal print cut Address Legerfmm TRAKU Print Menu and include) <br />VES—TYPE: SFR LJDUPLEX ❑ADU ❑INFILLDWELLING ❑MULTI -FAMILY ❑COMMERCIAL <br />❑ See Atlache l Leger, 2 copies (Permit Techs to Issue one copy to appraisal withpennyx scan one capyto Jeffrey Mars) <br />❑ Digital copy attached to permit recoM, Permit #_ <br />ElSaved to Address FOMer In Development Tech TOe <br />NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type_ <br />F4 NOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMR R OUIRED? <br />YES,Parmg#PW D NIA <br />R Stermwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRApT ❑ Inspeofens Added in TRAKR <br />NOT REQUIRED <br />0'l I71(I2Q2%i <br />Workaheet Completed B . Date: <br />Worksheet Completed By: �_4�2 Date: 71ZFIZOZZ <br />