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r <br />IF <br />EVERETT REVIEW W HEET <br />PUBLIC WORKS REV W WORKSS <br />WASHINGTON <br />PROJECT ADDRESS: 2610 HILLSIDE LN Permit #: B2101-041 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: ADDITIONS AND REMODEL 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 t main plus connections to building ❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Alteration ❑ Meter Only, Size - ❑ Per Cost Estimate <br />❑ Repair ❑ Water System evelopment Fee Total: $ <br />❑ Cap -off, qu tity ❑ Sewer Syst Development Fee Total: $ <br />❑ Reconne on to stub ❑ Water Se ice Line (behind meter), Size <br />❑ Back, <br />r Valve ❑ Backflo Prevention (Outside Building): ❑RPBA or ❑DCVA <br />YNOT QUIRED 1NOT QUIRED <br />xplan on/ Utility Permit #: Explan ion/ Utility Permit #: <br />IRRIGATION SE ICE: (Not Including Cost Estimates) FIRE SERVICE: Attach Cost Estimate /Request for Reference) <br />❑ New Conne on, Size ❑ New Conne ion, Size - ❑ Per Cost Estimate <br />❑ Meter One,Size ❑ 3/a" Detec eter Only, Service Size <br />❑ Water stem Development Fee Total: $ �ackflo Prevention (Outside Building): ❑ DCDA <br />�Back w Prevention (Outside Building): ❑ DCVA OT QUIRED <br />NO REQUIRE Explan ion/ Utility Permit #: <br />Expl ation/ Utili Permit #: <br />WATER DEP TMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑Yes, Qu tity ,See attached for reference. <br />NOT R UIRE <br />Plum ing ermits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />PBackflow evention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />RE UIRED <br />uilding P (Note: Permit Techni ns to add all items selected below to associated Building Permit <br />STORM TER SYSTEM DEVELOPMENT EE TRAFFIC MITIG ION FEES: <br />�rYE , See Attached for calculations / edit ❑ YES, Tra Mitigation Total: $ <br />T be added on PW Z 3 '0 0 2 To added on ❑ Sep Attached for calculations / credit <br />uantity charged 91�3 SF Qu ntity charged SFNO EQUIRED <br />QTY is ❑ Ground only J21 all hard surfaces Y is ❑ Roof only ❑ all hard surfaces <br />$ �56.1g <br />NOT REQUIRED <br />AWdWfonal Checklists: <br />�DDRESS LETTER REQ ? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />"YES — TYPE: ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />7Di <br />ached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />copy attached to permit record, Permit # <br />to Address Folder in Development Tech File <br />NOT <br />FIRE SPRIN REQUIRED? <br />❑ YES —T e <br />NNOT <br />QUIRED <br />so . <br />PUBLIC WORKS PERMIT REQUIRED? <br />RYES, Permit # PW 10 3- 0 0 2 <br />t(Stormwater NPDES Tab Completed in TRAKiT A(/ADA Tab Completed in TRAKiT '�Ynspections Added in TRAKiT <br />❑ NOT REQUIRED Worksheet Completed By: �� Date: 3 1 <br />zt l d <br />Worksheet Checked By: Date: <br />REVISED 1112712019 <br />