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lie • illee B`ill F E PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROIECTADDRESS: 1832 RUCKER AVE <br />DESCRIPTION OF WORK: LEVEL GRADE &Ol <br />] New Connection to main plus_ connections to building <br />] Alteration <br />Repair <br />] Cap off, quotas, <br />] Reconnection to stub <br />] Backwater Valve <br />] NOT REQUIRED <br />Explanation/Utility Permit <br />RIGATION SERVICE: (NM Including Cost Estimates) <br />] Meter Only, Size_ <br />] Water System Development Fee Total:$_ <br />] Backflow Prevention]Outside Building]:[] DNA <br />] NOTREQUIRED <br />Permit #: PIN2303-006 <br />PATIO IN BACKYARD <br />DDMESEIC WATER SERWCE: (Attach Calculation & Cost Est) <br />❑ New Connection, Size - []Per Cost Estimate <br />❑ Meter Only, Size_-[] Per Cost Estimate <br />Water System Development Fee ToGl:$_ <br />❑ Sewer System Development Fee Taal: $_ <br />❑ Water ServiR Lane (behind meter), Size_ <br />❑ Backflow Prevention (Outside Building):[] RPBA Q DCVA <br />® NOT REQUIRED <br />Explanation/Utility Permit <br />FIRE SERVICE. (Attach Cost Estimate/Requestfor Reference) <br />❑ New Connection, Size= [] Per Cost Estimate <br />❑ w' Detect Meter Only, Service Size <br />Backflow Prevention (Outside Building):[] DCDA <br />® NOT REQUIRED <br />Explanation/Utility Permit N_ <br />Explanation/Utility Permit N_ <br />ATER DEPARTMENT COST ESTIMATE NEEDED{IJye; PW Reviewer to send cast estimate request to Water Expectorant) <br />] Yes, Quantity See attached for reference. <br />Building): ❑ DNA Lor Oumestk servim) ❑ UsBar Bar Domestic servire) ❑ DCDA Vor Fire service) <br />] YES,Dj See Attached for calculations/credit <br />]YES, Traffic Mitigation Total:$_ <br />To be added on FW2303406 To be added an <br />❑ See Attached for calcuebons/credit <br />Quantity charged IMF Quandrycharged_SF <br />®NOT REQUIRED <br />QW is®Ground odds,[]all surfaces QTY Is[]Roof only []all surfaces <br />Sll S <br />)DRESS LETTER REQUIRED 2 (If Yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />]YES—TYPEDSFR ❑DUPLE% ❑ADU ❑INFILLDWELLING []MULTI -FAMILY []COMMERCIAL <br />❑ See Attached Letter, 2 copies (Permit Terchs to issue one copy to opelicont with perm Rs, scan one ropy to Jeffrey Marks) <br />❑ Digital copy attached to permit record Permit#_ <br />❑ Saved to Address Folder in Development Tech File <br />] NOT REQUIRED <br />f YES —Type <br />] NOT REQUIRED <br />Reason: <br />® Stormwater NPDESTab Completetlin TRAKT ®ADATab Completedin TRAKT ❑Inspections Addedin TRAKR <br />] NOT REQUIRED <br />Worksheet completed By: %/tad T(wcW¢o4t Date:03/30/2023 <br />Worksheet Recessed By: —— Date: <br />