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i. <br />E E R E T T <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 4320 THOMSON AVE Permit M B2104-040 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: NEW ONE STORY SFR <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, Size - ❑ Per Cost Estimate <br />❑ Repair ❑ Water System Development Fee Total: $ <br />❑ Cap -off, quantity ❑ Sewer System Development Fee Total: $ <br />® Reconnection to stub ® Water Service Line (behind meter), Size <br />❑ Backwater Valve ❑ Backflow Prevention (Outside Building): ❑RPBA ❑ DCVA <br />❑ NOT REQUIRED ❑ NOT REQUIRED <br />Explanation/Utility Permit # LA 22-p .0 6 Explanation/Utility Permit # Lz2Q5 , x , <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size ❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size ❑ %" Detect Meter Only, Service Size <br />❑ Water System Development Fee Total: $ ❑ Bac ow Prevention (Outside Building): ❑DCDA <br />revention (Outside Building): ❑DCVA ®N REQUIRED <br />❑ BackVQU <br />® NOTIRED xplanation/Utility Permit# <br />Explanation/Utility Permit # <br />WATER DE RTM ENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, antity , See attached for reference. <br />® NOT EQUIRED <br />Plumbing P rmits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />Backflow Prev ntion (Inside Building): ❑DCVA (for Domestic service) ❑RPBA (for Domestic service) ❑DCDA (for Fire service) <br />® NOT R UIRED <br />Building Permits (Note: Permit Techni fans to add all items selected belo o associated <br />Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT EES: <br />TRAFFIC MITIG ION FEES: <br />® YES, ® See Attached for calculations /credit �i2(p y_ �yD <br />❑YES, Tra Mitigation Total: $ <br />To be added on PW 2108-036 To be added on � <br />❑ e Attached for calculations/credit <br />Quantity charged 853 SF Quantity charged 3213 SF <br />®NOT EQUIRED <br />QTY is ® Ground only ❑ all surfaces QTY is ® Roof only ❑ all su aces <br />$228.43 860.44 <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 />® YES —TYPE: ® SFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ 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 # B2108-040 <br />® Saved to Address Folder in Development Tech File <br />❑ NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Ty <br />® NOT R QUIRED <br />Reason: <br />PUBLIC WORKS PER 1'f REQUIRED? <br />® YES, Permit # PWA 108-036 <br />® Stormwater PDES Tab Completed in TRAKiT ® ADA Tab Completed in TRAKiT Inspections Added in TRAKiT <br />❑ NOT REQUI D <br />Worksheet Completed By: ".4 y Date: OWIIJS1 %Q <br />Worksheet Completed By: Date: <br />REVISED 12222021 <br />