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EVERETT III PUBLIC WORKS REVIS WORKSHEET <br /> N41 <br /> PROJECT ADDRESS: 8514 0✓P.t.�STOW WOOD DR LOT (1)ts(ti us), AD Permit#: <br /> DESCRIPTION OF WORK:/l, PP y Wi �e ceals� r pyl FO 0,(4) ) � t(� A <br /> PW Reviewer to select all that a below: F <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 /> A <br /> X <br /> New Connection to main plus connections to building New Connection,Size Ey"I - ❑Per Cost Estimate <br /> _ Alteration Meter Only,Size -❑ Per Cost Estimate 'd�/ <br /> 14 <br /> ❑ Repair Water System Development Fee Total:$43111 4-2 % Oa: <br /> ❑ Cap-off,quantity Sewer System Development Fee Total:$5c81) I ZC,go CI4`JAI ' <br /> ❑ Reconnection to stub Water Service Line(behind meter),Size ' <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building):❑RPBA ❑DCVA <br /> ❑ NOT REQUIRED ,L 3 r 4 El NOT REQUIRED <br /> Explanation/Utility Permit# U . 0 1— 0 5 Explanation/Utility Permit# 02301 00S <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size ❑ New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building):❑DCDA <br /> ❑ Backflow Prevention(Outside Building):❑DCVA ❑ NOT REQUIRED <br /> ❑ NOT REQUIRED Explanation/Utility Permit# <br /> Explanation/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 /> Backflow Prevention(Inside Building): ❑ DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> ❑ 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 /> ❑ YES,❑See Attached for calculations/credit ❑YES,Traffic Mitigation Total:$ <br /> To be added on PW To be added on ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF ❑ NOT REQUIRED <br /> QTY is❑Ground only❑all surfaces QTY is❑Roof only❑all surfaces <br /> $ _— <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# <br /> ❑Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES Type <br /> ❑ NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑ YES,Permit#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> ri <I cy %II <br /> Worksheet Completed By: — Gj Date:4 '&l ze.z 3 <br /> ,- , 1 <br /> Worksheet Reviewed By: — —,44 Date: IZO Z3 <br />