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• • <br /> - EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1031 HOYT AVE Permit#: C2101-001 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ADD TO MASTER SUITE, NEW MASTER BATH, REVISE STAIRS TO <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 -0 Per Cost Estimate <br /> ❑Alteration ❑ Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity ❑ Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve `❑ ackflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> 4.NOT REQUIRED KNOT REQUIRED <br /> Explanation/Utility Permit#: xl lanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Connection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ ❑ Backflow Prevention (Outside Building): ❑ DCDA <br /> jBackflow Prevention (Outside Building): 0 DCVA 'KNOT REQUIRED <br /> NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(Ifyes, 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) 0 RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> XNOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> ❑ -•RMW TER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> YES, See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW To be added on C 2 A 0 I -001 ❑ See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 2-5'2. SF ►% NOT REQUIRED <br /> QTY is❑ Ground only 0 all hard surfaces QTY is Af Roof only5 all hard surfaces <br /> $ $ 3 <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 /> ❑YES—TYPE: ❑ SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> ❑See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits,scan one copy to Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> ❑Saved to Address Folder in Development Tech File C.5 FEE Ire Mut 0 F NETEPT(ON <br /> 14NOT REQUIRED p� <br /> FIRE SPRINKLERS REQUIRED? 2c?' Sf Eq3. <br /> El YES—Type NOT REQUIRED jib Tb C2kot-00 t 0.)0 etA) <br /> Reason: PE R, <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> NOT REQUIRED <br /> Worksheet Completed By: Date: 2-123r)4 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />