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EVERETT REVIEW W RK HEET 1121 PUBLIC WORKS REVI O S <br /> WASHINGTON <br /> PROJECT ADDRESS: 4918 24TH AVE W Permit#: B2106-047 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW(2)STORY SFR WITH ATTACHED GARAGE <br /> ' �/ CkPW Reviewer to select all that apply below: l� ��V ® �/� V� <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) ;1 <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost rj <br /> ❑ New Connection to main plus connections to building 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑ ap-off,quantity lie! Sewer System Development Fee Total: $ ii3OeReconnection to stubWater Service Line(behind meter), Size <br /> Backwater Valve Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <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 3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ q,Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ ackflow Prevention (Outside Building): 0 DCVA NOT REQUIRED <br /> IVOT REQUIRED Ex n ' n/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> 6 <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewe end cost estimate request to Water Department) <br /> es, Quantity , See attached for reference. <br /> Oyes, <br /> REQUIRED i« Of-will ft4 <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) 0 DCDA(for Fire service) <br /> 4NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> Sy6RMWA TER SYSTEM DEVELOPMENT FEES: T FFIC MITIGATION FEES: <br /> YES,11 See Attached fill-c-Iculations/credit /_ a ES,Traffic Mitigation Total: $ 3i ( • <br /> To be added on PW (9 0 To be added on D�db 0 See Attached for calculations/credit <br /> Quantity charged *;.1. SF Quantity c arged L$U 5F SF 0 NOT REQUIRED <br /> QTY is 0 Ground only 'all and surfaces QTY is Roof only 0 all hard surfaces -lg. b <br /> $❑ NOT REQUIRED Z33 "y� <br /> Additional Checklists: <br /> A DRESS LETTE REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES— PE: 4 SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> 111 ee Attached Letter, 2 copies (Permit Techs to Wig one cppy to Apacant with permits, scan one copy to Jeffrey Marks) <br /> igital copy attached to permit record, Permit# nAY24 tb—() <br /> aved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIFE SPRINKLERS REQUIRED? <br /> Nig YES—Type P ('I 13TD <br /> ❑ NOT REQUIRED fip5 f5J I(ZePC,��1 tr y f�� t1 P T CSC "VJ►�Do � 1 1 <br /> PVBLIC WORKS PET REQUIRED? <br /> lir YES, PPefmit#PW!—1 Os)- 07L <br /> 8 Stormwater NPDES Tar Completed in TRAKiT DADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: v l 6- Date: 3 <br /> Worksheet Checked By: --` Date: g Cc) _Z <br /> REVISED 11/27/2019 <br />