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EVERETT <br /> I iiiii PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1818 HOLBROOK AVE UNIT B Permit#: PW2109-063 <br /> TENANT: JAMIE GIBSON <br /> DESCRIPTION OF WORK: REPLACE EXISTING DRIVEWAY SURFACE <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 - ❑ Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑ Cap-off, q ntity 0 Sewer S stem Development Fee Total: $ <br /> ❑ Reconne tion to stub 0 Water ervice Line (behind meter), Size <br /> ❑ Backw er Valve 0 Backfl w Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> -NOT QUIRED SNOT EQUIRED <br /> Explan ion/Utility Permit#: _ _ Expla tion/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Conne tion, Size ❑ New Connection, Size - 0 Per Cost Estimate <br /> ❑ Meter Onl , Size 0 3/4" Detec Meter Only, Service Size <br /> ❑ Water S tem Development Fee Total: $ 0 Backflo Prevention (Outside Building): 0 DCDA <br /> ❑ Backflo Prevention (Outside Building): 0 DCVA IS-NOT QUIRED <br /> pl_NOT QUIRED Explan ion/Utility Permit#: <br /> Explan ion/Utility Permit#: <br /> WATER DE ARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Qu ntity , See attached for reference. <br /> h-NOT R QUIRED <br /> Plum i g Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Back ow Prevention (Inside Building): 0 DCVA (for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> �.NO REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selecKd be to associated Buildin Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC M IGATION FEES: <br /> a-YES, 0 See Attached for calculations/credit 0 YES,Tr ffic Mitigation Total: $ <br /> To be added on PW 2 to I- o Co 3 To be added onV 0 S Attached for calculations/credit <br /> Quantity charged ZsZS SF Quantity charged SF I AIOT EQUIRED <br /> QTY is 0 Ground only Wall hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ 7SD.5¢ $ <br /> 17aT REQUIRED <br /> Ad•itional Checklists: i <br /> A►I RESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES—TYPE: 0 SFR 0 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 /> ❑ Saved to Address Folder in Development Tech File <br /> VtitT>RECt6IRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> NOT REQUIRED <br /> Reason: <br /> PIJBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW Zl oq-o(n 3 <br /> Ar-Stormwater NPDES Tab Completed in TRAKiT FDA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> .7i____--- <br /> Worksheet Completed By- ' _% Date: L /I I Zo 22. <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />