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EVERETT <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 2000 TOWER ST Permit M B2203-037 <br />TENANT: ECC-INDEX LAWN CANOPY <br />DESCRIPTION OF WORK: NEW 730 SQFT CANOPY, ECC- INDEX LAWN, PACKAGE C <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 />❑ ❑Water System Development Fee Total: $ <br />❑ ntity ❑ Sewer System Development Fee Total: $ <br />❑ n to stub ❑ Water ervice Line (behind meter), Size <br />❑ alve ❑ B flow Prevention (Outside Building): ❑RPBA ❑ DCVA <br />/�anation/Utility <br />REQUIRED <br />® IRED P�I�anation/Utility <br />Exp Permit # Permit # <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size ❑ New C90nection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size ❑ %" D ect Meter Only, Service Size <br />❑ Water stem Development Fee Total: $ El B kflow Prevention (Outside Building): ❑DCDA <br />ElBacow Prevention (Outside Building): ❑DCVA ® OT REQUIRED <br />EQUIRED Explanation/Utility Permit # <br />® Ypl'a�nati <br />/Utility Permit # <br />WATER PARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes uantity ,See attached for reference. <br />® N REQU ED <br />Plumbin Permits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />Backflow evention (Inside Building): ❑DCVA (for Domestic service) ❑RPBA (for Domestic service) ❑DCDA (for Fire service) <br />® NO EQUIRED <br />rmit Tech clans to add all items selected be to associated <br />Building Permits (N=V�ELOPMENI <br />Building Permit) <br />STORMWATER SYSTEMFEES: <br />TRAFFIC MITIG TION FEES: <br />® YES, ® See Attac for calculation / credit n� <br />To be added on P To be added on 203-037 A <br />❑ YES, Tra itigation Total: $ <br />ee Attached for calculations/credit <br />�` <br />Quantity char d SF Quantity charg 783SF O <br />®N REQUIRED <br />QTY is ❑ round only ❑ all surface QTY is ® Ro only ❑ all aces <br />$ 197.64 <br />❑ NOT QUIRED <br />Additional Checklists: <br />ADDRESS LET R REQUIRED? (If yes (new assigned address), print out Address tter from TRAKiT Print Menu and include) <br />❑ YES — TY ❑ SFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />❑ See tached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />❑ Di ' al copy attached to permit record, Permit # <br />❑ S ved to Address Folder in Development Tech File <br />® NO REQUIR D <br />FIRE SPRI ERS REQUIRED? <br />❑ YES — pe <br />® NOT EQUIRED <br />Reas <br />PUBLIC WORKS PERMIT REQUIRED? <br />® YES, Permit # PW2203-012 <br />® Stormwater NPDES Tab Completed in TRAKiT ® ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKi <br />❑ NOT REQUIRED <br />Worksheet Completed By: Date: �& 'ZcYLZ <br />Worksheet Completed By: Date: <br />REVISED 12/22/2021 <br />