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EVERETT <br /> WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 3425 BELL AVE Permit#: B2109-047 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SFR REMODEL <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 -❑ Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ❑ Water System Development Fee Total:$ <br /> ❑ Cap-off, qu tity ❑ Sewer Syst m Development Fee Total: $ <br /> ❑ Reconne ion to stub ❑ Water ice Line(behind meter), Size <br /> ❑ Backw er Valve D Bac ow Prevention(Outside Building): ❑RPBA ❑ DCVA <br /> ® NOT EQUIRED ® N REQUIRED <br /> Expla ation/Utility Permit# Explanation/Utility Permit# <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connect' n, Size ❑ New Connection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only ize ❑ 3/4' Detec eter Only, Service Size <br /> ❑ Water S tem Development Fee Total: $ ❑ Backfl Prevention(Outside Building): ❑DCDA <br /> ❑ Backfl Prevention(Outside Building): ❑DCVA ® NO EQUIRED <br /> ® NOT EQUIRED E planation/Utility Permit# <br /> Exp nation/ tility Permit# <br /> WATER D ARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, antity , See attached for reference. <br /> ® NOT EQUI-'. <br /> Plum ing ''ermits(Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Backflow Pr: ention(Inside Building): ❑DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> ® NOT -' QUIRED <br /> ildi •g Permits (Note:Permit Technicians to add all items selecte elow to associated Building Perini <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITI .TION FEES: <br /> ❑ YES, ❑ See Attached for calcul do s/credit ❑YES,Tr. c Mitigation Total: $ <br /> To be added on PW To be added on ■.ee Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF ® N• REQUIRED <br /> QTY is❑ Ground only❑ all surfaces QTY is❑ Roof only❑ all surfac <br /> $ <br /> ® OT REQUIRE <br /> Additional C ecklists: <br /> ADDRESS LET ER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ® YES—TY : ® SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> ® See tached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ® Dig'al copy attached to permit record, Permit#B2109-047 <br /> ® S ed to Address Folder in Development Tech File <br /> ❑ NOT EQUIRED <br /> FIRE SP NKLERS REQUIRED? <br /> ❑ YE —Type <br /> • N T REQUIRED <br /> Re on: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑ YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ® NOT REQUIRED <br /> Worksheet Completed By• '7 Date: J/1 2 Z- <br /> 47110 <br /> Worksheet Completed By: Date: AS <br /> REVISED 12/22/2021 <br />