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im E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> iimm WASHINGTON <br /> PROJECT ADDRESS: 2327 73RD ST Permit#: PWW2101-001 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: GRADE/FILL MATERIAL TO SMOOTH OUT YARD FOR MOWING&MAINT <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 0 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 /> ❑ Recon ection to stub 0 Water rvice Line(behind meter), Size <br /> Back ater Valve ❑ ack Prevention (Outside Building): 0 RPBA or CI DCVA <br /> NOT REQUIRED ` NNO EQUIRED <br /> Expl ation/Utility Permit#: Expl ation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Conne tion, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only Size ❑3/4" Det ct Meter Only, Service Size <br /> ❑Water Sy em Development Fee Total:$ 0 Back w Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow revention (Outside Building): 0 DCVA NO EQUIRED <br /> NOT R QUIRED Expl ation/Utility Permit#: <br /> Explanati n/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, 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 /> ❑,:ackflow evention (Inside Building): ❑ DCVA(for Domestic service) ❑ RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> ;'41 NOT RE IRKED <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 /> ❑YES, 0 See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW To be added on m See Attached for calculations/credit <br /> Quantity ch rged SF Quantity charged SF •4 OT REQUIRED <br /> QTY is ❑ round only 0 all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> /' $ <br /> !\NOT R UIRED <br /> Additional Checklists: <br /> ADDRESS LETTER EQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: 0 FR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See At ched Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digita copy attached to permit record, Permit# <br /> / 0 Sav to Add ess Folder in Development Tech File <br /> E" OT REQUIRED . <br /> FIRE SPRINKLERS EQUIRED? <br /> ❑ E —Type <br /> aT REQUIR <br /> Re.son: <br /> P,_.BLIC WORKS PERMIT RED(,UI <br /> El OT R QRED� <br /> Z1 ES, Pe it#PW 7 <br /> StormwaterUIRED NPDES Tab Com eted in TRAKiT ADA Tab Completed in TRAKiT Inspections Added in TRAKiT <br /> Works'eet Completed By: A4 Date: 2t 2/f2 Q <br /> Worksheet ' ecked B • Date: <br /> REVISED 11/27/2019 <br />