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EVE RETT <br /> ICWASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: &2_0 '\z-- T. 524,i 33D Permit#: G LO o(,-pol <br /> DESCRIPTION OF WORK: lh074,11 ytiii,u IN\ kt.f-. t-fDYKQi 'WIT) G.St13 610f 'i tiUY . <br /> PW Reviewer to select all that apply below: J <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 /> El Alteration ❑ Meter Only,Size -❑Per Cost Estimate <br /> ❑ Repair ❑ Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity ❑ Sewer System Development Fee Total:$ <br /> ® Reconnection to stub Water Service Line(behind meter),Size3]y4 <br /> ElBackwater Valve U Backflow Prevention(Outside Building):❑RPBA ❑DCVA <br /> ❑ NOT REQUIRED ,r 2 ❑ NOT REQUIRED <br /> Explanation/Utility Permit#V 1305 -UZ:L Explanation/Utility Permit# U L'OS - U LI- <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 ❑ W'Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ El Backflow Prevention(Outside Building):❑DCDA <br /> ❑ Backflow Prevention(Outside Building):❑DCVA gC NOT REQUIRED <br /> O 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 /> El Yes,Quantity ,See attached for reference. <br /> Fig 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) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> fg] NOT REQUIRED <br /> Building Permits( te:Permit Technicians to add all items selected below to associated Building Permit) <br /> ORMWATER STEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ,g a Attached f• Iations/credit - ❑YES,Traffic Mitigation Total:$ <br /> To b dded Ion PW (S, be added o 206 of ❑See Attached for calculations/credit <br /> antity charged - Q ity c rged 13(p6SF is U6.J NOT REQUIRED <br /> TY i Ground only El all surfaces QTY is F:-'• if only❑all surfac <br /> 1. .55- - '''-%'7 <br /> k____NOT REQUIRED <br /> V <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address),print out Address Letter from TRAKiT Print Menu and include) <br /> V YES-TYPE:[,gSFR ❑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#2 2..0b(Q-obi <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> El YES-Type <br /> M NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> El YES,Permit#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> tgl NOT REQUIRED <br /> Worksheet Completed By: 7400 qe,14/144 Date: O5 I I.Di 2-02-3 <br /> Worksheet Reviewed By:i , Date: S (0 Zo23 <br />