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`EVERETT PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECTADDRESS: 2000 TOWER ST Permit#: PW2203-012 <br />TENANT: ECCJNDEX LAWN <br />DESCRIPTION OF WORK: SITE IMPROVEMENTS FOR ECC- INDEX LAWN, PACKAGE <br />PW Reviewerto select all that applybeew. <br />Utility Permits (Nate: Permit Techncians to Create Utility Palms far Sewer, Water, Fire, and Imgarron, as selected below) <br />SAN RYSEWER: I WATER �ERVICE:(AttachC&Cost Est.) <br />MTConnection, <br />New Connepa to main plus _convections to building Size Cast Estimate <br />_-OPer <br />® Afteration [] Meter Only, Sae= ❑ Per Cast Estimate <br />Lj Repair ❑ Water System Development Fee TOM: $_ <br />Cep -of, quantity _ ❑ Sewer System Development Fee Total: $_ <br />Reconnection to stub ® Water Service Line (behind meter), Size Xl <br />Ba kwater Valve ❑ Backflow Prevention (Outside Suicide): []RPBA [] DCVA <br />NOT REQUIRED ❑ NOT REQUIRED <br />ExplanatlonUtlity Permit#_ ExplanatbnlUtlllty Permit A <br />IRRIGATION SERVICE: had Including Cost Estimates) FIRE SERVICE: (Attain Cost Estimate/ Request or Rerarence) <br />New Connection, Size _ New Connection, Size = ❑ Per Cost Estimate <br />Meter Only, Size_ ❑ Y," Dstecl Mend Only, Service Size _ <br />Water System Development Fee Total: $_ ❑ Backflow Prevention (Outside Building): []DCDA <br />❑ Bacl Prevention (Outside Building): []DCVA E NOT REQUIRED <br />E NOT REQUIRED ExplanationlUtility Permit #_ <br />ExplanatiDNUblity Permit # _ <br />WATER DEPARTMENT COST ESTIMATE NEEDED -(Dyes, PW Reviewer N sees cost estimate request to Water Department) <br />[] Yes, Quantity—. See attached for reference. <br />E NOT REQUIRED <br />Plumbing Permits (Note: Permit Technksms As add all items selecadbelow to Plumbing Permit-loritems Inside building only) <br />Backfiow Prevention (inside Building) r []DCVA(for Domesficservice) []RPBA(for Domesticservice) []DCDAde Fireservice) <br />E NOT REQUIRED <br />Building Permits (Note: Permit Technicians to addall items selessuf below to associated <br />Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />FFI MITIGATI NFEE - <br />YES, See Attached for calculaiars I credit <br />YES,TreRc Mitigation Total:$_ <br />To be added on PW2203-012 To be added on <br />[]See Attached for calculadonecredit <br />Quantity charged 3400SF Quantity charged_ _SF <br />D NOT REQUIRED <br />CITY is E Ground only [] all surfaces OW is [] Roof only [] all surfaces <br />$910.52 <br />_ <br />[] NOT REQUIRED <br />Additional Checklists: <br />AODRE LETTER RE NRED4 (if yes (new assigned annual print out Address Letterfmm TRAIOT Print Menu and include) <br />VES—TYPE: SFR Lj DUPLEX ❑ADU ❑ INFILL DWELLING ❑MULTI -FAMILY ❑COMMERCIAL <br />❑ See Attached Latter, 2 copies (Pli m#Techs to issue one copy to applicant with permits, seen one copy M Jerrey Marks) <br />❑ Digital copy attached M permit record. Fell #_ <br />❑ Saved to Morass Folder in Development Tech File <br />E NOT REQUIRED <br />FIRE SPRINKLERS <br />[] YES —Type_ <br />E NOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />E YES, Permit # PW2203-012 <br />E Stormwater NPDES Tab Completed In TRAl E ADA Tab Completed In TRAKIT E Inspections Added In TRAKIT <br />[]NOT REQUIRED <br />Workshee[Completetl By: Date: 07/09/2022 <br />Wamksheet Completed By: Date: <br />REVISED wiNscim <br />