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_ � s <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1924 WETMORE AVE Permit#: B2101-023 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONSTRUCT WOOD FRAME GARAGE <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 /> ❑,:ackwater Valve ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> F NOT REQUIRED KNOT 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 /> ❑ Meter Only, Size 0 3 " Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ ❑packflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA KNOT REQUIRED <br /> OT REQUIRED Explanation/Utility Permit#: <br /> xplanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ es, Quantity , See attached for reference. <br /> Oyes, <br /> REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Nackflow Prevention (Inside Building): ElDCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> OT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> SJORM TER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> AYES, See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW 210 3- 05 5 To be added on See Attached for calculations/credit <br /> Quantity charged 511O SF Quantity charged SF p'N❑OT REQUIRED <br /> QTY is 14 Ground only 0 all hard surfaces QTY is 0 Roof only❑all hard surfaces <br /> 3lf $ <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: 0 SFR ❑ DUPLEX 0 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 /> ❑ Digital copy attached to permit record, Permit# <br /> 0 Saved to Address Folder in Development Tech File <br /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> KNOT REQUIRED <br /> Reason: <br /> UBLIC WORKS PERMIT REQUIRED? <br /> istYES, Permit#PW Z103-b 55 <br /> �Stormwater NPDES Tab Completed in TRAKiT %ADA Tab Completed in TRAKiT %Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: 31 1-3 f')-k <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />