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EVERETT 0 <br /> PUBLIC WORKS REVIEI WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 8514 SHADOW WOOD DR LOT 3 (t' (5flwj SFK) Permit#: <br /> DESCRIPTION OF WORK: NLw Suvev Co4oted'oh 6,r FOR SHORT PLAT IMPROVE ENT <br /> PW Reviewer to select all that apply below: �Y( C-h 5 ��0( (s i '`L l b SE;µrfi►% <br /> UtilityPermits (Note:Permit Technicians to Create UtilityPermitfor Sewer, Water Sire and Irrigation,as selected below) <br /> 9 <br /> AITARY SEWER: DOMESTIC WATER SERVICE:(Attach Calculation&Cost Est.) <br /> New Connection to main plus connections to building El New Connection,Size - El Per Cost Estimate <br /> Alteration ❑ Meter Only,Size -El Per Cost Estimate <br /> ❑ Repair T 8 El Water System Development Fee Total:$ <br /> ❑ PC9�; co Cap-off,quantity S h 0 ur Sewer System Development Fee Total:$$M O 4-15% 0 <br /> ❑ Reconnection to stub7&4/ NX.- -� rG<i ElWater Service Line(behind meter),Size CI , <br /> ❑ Backwater Valve EL Backflow Preventi.Outside Building):El RPBA El DCVA t I WA <br /> ❑ NOT REQUIRED 4 1�51 " "tH ❑ NOT REQUIREDW,%-[5+I ut CCM n ec-{je vJ 3 y� <br /> .� 1 <br /> Explanation/Utility Permit# 'J2304-004 Explanation/Utility Permit# U 23o4--00+ <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> El New Connection,Size El New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only,Size El %"Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ El Backflow Prevention(Outside Building):El DCDA <br /> El Backflow Prevention(Outside Building):El DCVA ❑ NOT REQUIRED <br /> ❑ 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 /> ❑ 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) El 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 El See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF El NOT REQUIRED <br /> QTY is El 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 /> El YES-TYPE:❑SFR El DUPLEX ❑ADU ❑INFILL DWELLING El MULTI-FAMILY ❑COMMERCIAL <br /> El 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 /> 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 El Inspections Added in TRAKiT <br /> El NOT REQUIRED <br /> C.%-r—c.S& <br /> Worksheet Comp e B (12/LDate: 4-(V1( <br /> 23 Worksheet Reviewed By: � D_/ ate: y a 6�� <br />