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EVERETT • <br /> PUBLIC WORKS REVIES WORKSHEET <br /> WM WASHINGTON <br /> PROJECT ADDRESS: 8514 SHADOW WOOD DR LOT L a2cyky 14t'1 B)Permit#: <br /> DESCRIPTION OF WORK:5 ) W(fai' (ayi50; FOR NJj bi4 /� _� <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 f,� de <br /> El Repair Water System Development Fee Total:$'131 E # c Z5 Qw` '` <br /> El Cap-off,quantity Sewer System Development Fee Total:ono I-26.6 C" <br /> ElReconnection to stub Water Service Line(behind meter),Size (A r <br /> ❑ Backwater Valve El Backflow Prevention(Outside Building):El RPBA El DCVA <br /> ►tit NOT REQUIRED El NOT REQUIRED <br /> Explanation/Utility Permit# Explanation/Utility Permit# U 2D 4--a35 <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size El New Connection,Size -El Per Cost Estimate <br /> El Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> El Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building):❑DCDA <br /> El Backflow Prevention(Outside Building):❑ DCVA El NOT REQUIRED <br /> ❑ NOT 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 /> El 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): El DCVA(for Domestic service) El RPBA(for Domestic service) El DCDA(for Fire service) <br /> El NOT REQUIRED <br /> Building Permits(Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMW ATER 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 El See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF El NOT REQUIRED <br /> QTY is El Ground only El all surfaces QTY is El 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 /> El 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 /> El Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES Type <br /> El NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> El YES,Permit#PW <br /> El Stormwater NPDES Tab Completed in TRAKiT El ADA Tab Completed in TRAKiT El Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> 1 (30,-- I <br /> Worksheet Completed By: J Date: 4 Z(- 1 ZO! 3 <br /> Worksheet Reviewed By: — — Date: 11 I ,, .11 ow 3 <br />