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• <br /> ix E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 709 80TH ST SW Permit#: B2108-006 <br /> TENANT: AMERICAN TOWER <br /> DESCRIPTION OF WORK: MODIFYING GROUND-BASED&TOWER-MOUNTED EQUIPMENT <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 0 Meter Only, Size - 0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line (behind meter), Size <br /> ❑.Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ICJ-NOT REQUIRED ]'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 /> 0 Meter Only, Size 0 %" Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total: $ Cj Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA 01q0T REQUIRED <br /> I PLOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> L.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) 0 DCDA (for Fire service) <br /> WA-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 /> i ee Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW To be added on -C-6 a'66tr A 0 See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 12' SF la-NOT REQUIRED <br /> QTY is 0 Ground only ❑ all hard surfaces QTY is❑ Roof only hall hard surfaces <br /> $ $ 31. BC. <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 /> 0 YES—TYPE: 0 SFR 0 DUPLEX ❑ ADU ❑ INFJLL DWELLING ❑ 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 /> ❑ Digital copy attached to permit record, Permit# <br /> O Saved to Address Folder in Development Tech File <br /> fENOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> 04-NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑ YES, Permit#PW <br /> ,,// 0 Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> SNOT REQUIRED / <br /> Worksheet Completed By: Date: O S f .i V <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />