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EVERETT PUBLIC WORKS REVIEW WORK SHEET <br /> u o s s <br /> LI WASHINGTON <br /> PROJECT ADDRESS: 5126 51ST PL SW Permit#: B2102-062 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW CONSTRUCTION OF SFR BUILD ON VACANT LOT <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 /> New <br /> SEWER: ESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br /> NNew Connection to main plus / connections to building Skew Connection, Size 3! - 0 Per Cost Estimate <br /> ❑Alteration ❑ Meter Only, Size - 0 Per Cost Estimate <br /> O Repair ligWater System Development Fee Total: $ 4. (9 G,oca <br /> ❑ Cap-off, quantity aSewer System Development Fee Total: $ S_ 4-z2.c.'o <br /> O Reconnection to stub ❑ Water Service Line (behind meter), Size <br /> 0 Backwater Valve Ca Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Z-<03 ' C; t '6 Explanation/Utility Permit#: U Z.t a 3-o <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 /> O Water System Development Fee Total: $ q Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA &NOT REQUIRED <br /> I14OT REQUIRED Explanation/Utility Permit#: <br /> xplanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> CI 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 /> O Backflow Prevention (Inside Building): 0 DCVA (for Domestic service) 0 RPBA (for Domestic service) 0 DCDA(for Fire service) <br /> 19-NOT 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 /> Gd--YES,A-See Attached for calculations/credit lilLYES,Traffic Mitigation Total: $3. t 47.00 <br /> To be added on PW 210 4-0.3! To be added on 0 See Attached for calculations/credit <br /> Quantity charged .3114. SF Quantity charged SF 0 NOT REQUIRED <br /> .QTY is 0 Ground only all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ $Zo• Co 7 $ <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> A4DRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> iff-YES-TYPE: [ SFR 0 DUPLEX ❑ ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ,See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> Ef Digital copy attached to permit record, Permit# "RAJ Zt o 4 <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> O YES-Type <br /> SNOT REQUIRED <br /> Reason: <br /> POLIC WORKS PERMIT REQUIRED? <br /> ES, Permit# PW 2--'o 4- c'.S 5 <br /> p4tormwater NPDES Tab Completed in TRAKiT ,likADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED Worksheet Completed By: v`��G•.--•- Date: D 4-1/4"—Z I <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />