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EVERETT • <br /> PUBLIC WORKS REVIEe WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 8514 SHADOW WOOD DR LOT a CNGw SC R, Permit#: <br /> DESCRIPTION OF WORK: Kit() WQ r,v 4 Stu/4.,/COknIl l p 4 FOR NGw S r< <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 /> S NITARY SEWER: MESTIC WATER SERVICE: Attach Calculation&Cost Est.) <br /> New Connection to main plus i connections to building New Connection,Size 3 i. - ❑Per Cost Estimate <br /> Alteration Meter Only,Size -❑ Per Cost Estimate e, <br /> ❑ Repair Water System Development Fee Total:$4311 #14% 0i'l' ,4 <br /> ❑ Cap-off,quantity Sewer System Development Fee Total: SfiQ t t50/0 O'‘ j <br /> ❑ Reconnection to stub Water Service Line(behind meter),Size Vt0. <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building):❑RPBA ❑DCVA <br /> ❑ NOT REQUIRED ElNOT REQUIRED <br /> Explanation/Utility Permit# V nOi—p°b Explanation/Utility Permit#U -304_OO(D <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size ❑ New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ ❑ 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 /> --1-a0✓ SdYt <br /> p <br /> Worksheet Completed BY: — Date: q(2.4(7.0 z 3 <br /> �� <br /> Worksheet Reviewed By: — Date: <br />