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AOL <br />EVERETT <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 1011 GRAND AVE Permit M B2112-052 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: ADDITION OF 482 SQ FT TO EXTG SFR <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 - ❑ Per Cost Estimate <br />❑ Repair ❑Water System Development Fee Total: $ <br />❑ Cap -off, qu tity ❑ Sewer Sy tem Development Fee Total: $ <br />rvice Line (behind meter), Size <br />❑ Reconne ion to stub ❑ Water ew <br />❑ Backw er Valve ❑ Back Prevention (Outside Building): ❑RPBA ❑ DCVA <br />® NOT EQUIRED ®NO REQUIRED <br />Explan ion/Utility Permit # Expla ation/Utility Permit # <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, 9ze ❑ 3/4" Det t Meter Only, Service Size <br />Development Fee Total: $ ❑ Bac ow Prevention (Outside Building): ❑DCDA <br />❑ Wat/91 <br />❑ Bacention (Outside Building): ❑DCVA ® N REQUIRED <br />® NOTED planation/Utility Permit # <br />Expltility Permit # <br />WATER DEPA MENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, Quanti , See attached for reference. <br />® NOT RE IRED <br />Plumbi g 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 oe <br />rilding Permits (Note: Permit Technicians to add all items selected ow to associated <br />Building Pe it) <br />s1irORMWATER SYSTEM DEVELOPMENT FEES: <br />TRAFFIC M GATION FEES: <br />® YES, ❑ See Attached for calculations / credit <br />❑ YES, affic Mitigation Total: $ <br />To be added on PW To be added on B2112-052 <br />KjSee Attached for calculations/credit <br />Quantity charged SF Quantity charged 327 SF <br />® T REQUIRED <br />QTY is ❑Ground only ❑all surfaces QTY is ❑Roof only ®all surfaces <br />$ 87.57 <br />❑ T REQUIRED <br />Additional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Add ss Letter from TRAKiT Print Menu and include) <br />❑ YES — TYPE: ❑ SFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLIN ❑ 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 />❑ Digit copy attached to permit record, Permit # <br />❑ S ed to Address Folder in Development Tech File <br />® NOT EQUIRED <br />FIRE SPR KLERS REQUIRED? <br />❑ YES ype <br />® NO REQUIRED <br />Reason: <br />PUBLIC WORKS RMIT REQUIRED? <br />❑ YES, Permit PW <br />❑ Storm ter NPDES Tab Completed in TRAKiT ❑ ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br />UIRED <br />® NOTZorksheet <br />Completed By: !$ Date: <br />_4; <br />OLj <br />Worksheet Completed By: Date: <br />REVISED 1212212021 <br />