Laserfiche WebLink
lae IF laa R`illae F E PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROIECTADDRESS: 620 MILLWRIGHT LOOP N Permit If PW2303-021 <br />DESCRIPTION OF WORK: BOXCAR PARK LIFT STATION REPLACEMENT <br />] New Con rare onto main plus _con nections to building <br />] Alteration <br />Repair <br />] Cap off, euandty <br />] Reconnection to stub <br />] Backwater Valve <br />] NOT REQUIRED <br />Explanation/Utility Permit al <br />RIGATION SERVICE: (NM Including Cost Estimates) <br />] Meter Only, Size_ <br />] Water System Development Fee Total:$_ <br />] Bad ow Prevention(Outside Building):[] DIVA <br />] NOTREQUIRED <br />DOMESTIC WATER SERWCE: (Attach Calculated & Cost Earl <br />❑ New Connected, Size - Q Per Cost Estimate <br />❑ Meter Only, Size_-[] Per Coal Estimate <br />❑ Water System Development Fee TOGI:$_ <br />❑ Sewer System Development Fee TMaL$_ <br />❑ Water Service Une(behind meter), Size_ <br />❑ BackRow Prevention (Outside Building):[] RPBA Q DIVA <br />® NOT REQUIRED <br />Explanation/Nility Permit <br />FIRE SERVICE. (Attach Cost Estimate/Requestfor Reference) <br />❑ New Connection, Size= [] Per Cost Estimate <br />❑ %" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building):[] DCDA <br />® NOT REQUIRED <br />Explanation/Utility Permit#_ <br />Explanation/Ublity Permit #_ <br />ATER DEPARTMENT COST ESTIMATE NEEDED{Ifyrs, PW Reviewer to send cost estimate request to Water Commitment) <br />] Yes, Quantity . See attached for repeated. <br />Building): ❑ MA lot Oumealk servim) ❑ RP BA Der Dondi servire) ❑ DCDA hour Fire servire) <br />] YES, L] See Attached for calculations/cod! @ YES, Traffic Mitigation Tend l:$_ <br />To be added on PW To be added an ❑ See Attacked! for alculetions/credit <br />Quantity charged _SF Quandtyeftarged_SF NOT REQUIRED <br />QTy is [] Ground only[] all surfaces CITY Is[] Roof only[] all surfaces <br />$- S <br />)DRESS LETTER REQUIRED P (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />]YES—TYPEDSFR ❑DUPLEX ❑ADU ❑INFILLDWELLING []MULTI -FAMILY []COMMERCIAL <br />❑ See Attached Letter, 2 mples (Pnmlt Tee& to Issue one ropy to applicant with permits, scan one ropy to Jeffrey Moi <br />❑ Digital copy attached to permit recoN, Permit p_ <br />❑ Saved to Address Folder in Development Tech File <br />] NOT REQUIRED <br />) YES —Type <br />] NOT REQUIRED <br />Reason: <br />®Stormwater NPDESTab Completedin TRAKT ®ADATab Compleptlin TRAKT ❑ Inspections Added in TRAKT <br />] NOT REQUIRED <br />Worksheet completed By: %/tad Date: 0313012023 <br />Worksheet Renewed By: —— Date: <br />