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EVERETT0 <br /> WAS R I N G TO N PUBLIC WORKS REVI E WORKSHEET <br /> PROJECT ADDRESS: 8514 SHADOW WOOD DR LOT 3 (i,t4i D we.t('kj) Permit#: <br /> DESCRIPTION OF WORK: it.s e( 5e,f 0:CI- <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: ttach Calculation&Cost Est.) <br /> El New Connection to main plus connections to building New Connection,Size✓ 'f n- El Cost Estimate <br /> ❑ A• lterationM Meter Only,Size -El Per Cost Estimate �de <br /> ❑ R• epair ►: Water System Development Fee Total:$f 3f( +t 4% 0 ' F5 <br /> ❑ Cap-off,quantity 4 Sewer System Development Fee Total:$65 O f' 25 fib ("1 (/' <br /> El Reconnection to stub El Water Service Line(behind meter),Size <br /> ❑ Backwater Valve El Backflow Prevention(Outside Building):El RPBA ❑DCVA <br /> El NOT REQUIRED El NOT REQUIRED <br /> Explanation/Utility Permit# Explanation/Utility Permit# 0-304— 03g <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> El New Connection,Size El New Connection,Size -El Per Cost Estimate <br /> El Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> El Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building):El DCDA <br /> El B• ackflow Prevention(Outside Building):❑ DCVA ❑ NOT REQUIRED <br /> El NOT REQUIRED Explanation/Utility Permit# <br /> Explanation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes,PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes,Quantity ,See attached for reference. <br /> El 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) ❑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 /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> El YES,El See Attached for calculations/credit El 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 El NOT REQUIRED <br /> QTY is El Ground only El all surfaces QTY is El Roof only❑all surfaces <br /> $ $ <br /> ❑ N• OT 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 El COMMERCIAL <br /> See Attached Letter,2 copies(Permit Techs to issue one copyto applicant withpermits,scan one copyto Jeffrey <br /> ❑ p PP Marks) <br /> ❑Digital copy attached to permit record,Permit# <br /> ❑Saved to Address Folder in Development Tech File <br /> El NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> El YES Type <br /> El NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> El YES,Permit#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT El ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> El NOT REQUIRED <br /> r-JC-.9 111/415°14- <br /> Worksheet Completed By: J Date: 1-1 I 4-10( 2-3 <br /> (Z..6 <br /> Worksheet Reviewed By: Date: v"�5 <br />