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EVERETT <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> I IWASHINGTON <br /> PROJECT ADDRESS: 433 ROCKEFELLER Permit#: PW2007-002 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CLEARING FOR NEW SFR-LOTS 16&17 <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 /> pl:New Connection to main plus I connections to building Cif.New Connection, Size 3/4 -0 Per Cost Estimate <br /> ❑Alteration ❑ Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair ittNater System Development Fee Total:$ 4, 190.oo <br /> ❑ Cap-off,quantity Sewer System Development Fee Total: $ AS,4ZZ.00 <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED U I CI NOT REQUIRED I <br /> Explanation/Utility Permit#: �ZI'- d ` I Explanation/Utility Permit#: V1,2-t -0 L <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): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA 0 NOT REQUIRED <br /> a-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 /> -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) ❑ RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> KNOT 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 /> 0-YES, Stormwater Total: $ J. o 4V. B 4 It-YES,Traffic Mitigation Total: $ 3, I4-. 00 <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> ps-All Hard Surface Fees to be added to Permit# p1N 2061-00 2 0 NOT REQUIRED <br /> lig-See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> AYES— PE: -6FR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ee Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> L' l igital copy attached to permit record, Permit# Rtil 2 od1 <br /> 6Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> INOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW DOL <br /> (, -Stormwater NPDES Tab Completed in TRAKiT cDA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed BY Date: G18/O .a Z-1 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />