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• • <br /> EVE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> Num WASHINGTON <br /> PROJECT ADDRESS: 620 112TH ST SE#213 Permit#:B2104-057 <br /> DESCRIPTION OF WORK: NEW MANUF HOME IN EXTG MANUF HOME PARK W/STEPS&DECK <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:(Attach Calculation&Cost Est.) • <br /> ❑ New Connection to main plus connections to building ❑ New Connection,Size - ❑Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only,Size -0 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),Size 3/4" <br /> O Backwater Valve ,{ ❑ Backflow Prevention(Outside Building):❑RPBA ❑DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED <br /> 1 6Z9- <br /> U2 . . OG <br /> Explanation/Utility Permit# Explanation/Utility Permit# ✓' 02`� <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size ❑ New Connection,Size -0 Per Cost Estimate <br /> ❑ Meter Only,Size 0 %"Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building):❑DCDA <br /> ❑ Backflow Prevention(Outside Building):0 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) ❑DCDA(for Fire service) <br /> ® NOT REQUIRED <br /> Building Permits(Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STOR WATER SYS EM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> • YES, S ttached for calculations/credit ❑YES,Traffic Mitigation Total:$ <br /> To ed on PW To b Ided on 2 04-057 ❑See Attached for calculations/credit <br /> uantity c rged SF Quantity c ed 1458SF O ® NOT REQUIRED <br /> QTY is❑Ground only❑all surfaces QTY• Roo ly❑all surfac <br /> $ 90.45 <br /> NOT REQUIRED <br /> VVVV ���` ec lists: <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# B2104-057 <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 /> Worksheet Completed By: -744Aaryetqezmetpt Date: 05/08/2023 <br /> 23 <br /> n <br /> Worksheet Reviewed By: / � 40 Date: O5/O9/2023 SI I0 <br />