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EVERETT <br /> 1112 PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1313 50TH ST Permit#: C2008-002 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: 544 SQ FT ADDITION AND 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, ize -❑ Per Cost Estimate <br /> ❑ Repair 0 Water Syst Development Fee Total: $ <br /> ❑Cap-off,q ntity ❑ Sewer S em Development Fee Total: $ <br /> ❑ Reconn tion to stub ❑Water rvice Line(behind meter),Size <br /> ❑ Backw er Valve 0 Back w Prevention (Outside Building): ❑ RPBA or❑ DCVA <br /> rit NOT EQUIRED NO REQUIRED <br /> Expla ation/Utility Permit#: Explanation/U 'lity Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERV E: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Co nection, Size -0 Per Cost Estimate <br /> ❑ Meter O y, Size ❑3/"De ct Meter Only, Service Size <br /> ❑Water ystem Development Fee Total:$ 0 Bac ow Prevention (Outside Building): 0 DCDA <br /> ❑ Back w Prevention (Outside Building): 0 DCVA IX N REQUIRED <br /> ed NO REQUIR-1 Explanation/Utility Permit#: <br /> Exp ation/U ' ty Permit#: <br /> WATER D-•ARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, e ,antity , See attached for reference. <br /> IX NOT •EQUIRED <br /> Plumbing ermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflo revention(Inside Building): ❑ DCVA(for Domestic service) ❑ RPBA(for Domestic service) ❑ DC A(for Fire service) <br /> Ill NOT QUIRED <br /> Building Permits (Note:Permit Technicians to add all ite s se e below to associated Building P it) <br /> Building <br /> SYSTEM DEVELOPMENT FEES: TRAFFIC MIT ATION FEES: <br /> XI YES, Stormwater Total: $ 262.77 0 YES,Tr is Mitigation Total: $ <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 S Attached for calculations/credit <br /> ti All Hard Surface Fees to be added to Permit# PW2012-002 ti NO EQUIRED <br /> Irl See Attached Spreadsheet for calculations/credit <br /> ❑ NOT REQUIRED <br /> al Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: SFR ❑ DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> ❑See ttached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Di tal copy attached to permit record, Permit# <br /> ❑ ved to Address Folder in Development Tech File <br /> it NOT RE UIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> ki NOT REQ IRED <br /> Reason: <br /> PUBLIC ORKS P RMIT REQUIRED? <br /> OYES, Permit# 2012-002 <br /> (11 Stor ater NPDES Tab Completed in TRAKiT 11 ADA Tab Completed in TRAKiT 14 Inspections Added in TRAKiT <br /> 0 NOT REQUI ED <br /> Worksheet Completed By: AH Date: 2/16/21 <br /> Worksheet Checked By: Date: <br /> 1 <br /> REVISED 11/27/2019 <br />