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`EVERETT PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROIECTAIEDRESS: 9608 to AVE SE Permit N: U2305-012 <br />DESCRIPTION OF WORK: New Irrigation Service to Vacant ast <br />PW Reviewer to select all that apply below: <br />willty Permits (Note: Permit Technicians to Create Utility Permajor Sewer, Water, Fire, and Irrigmbn as selected below) <br />SANITARYSEWER: DOMESTIC WATER SERVICE: (Attach Calculation & Cog Earl <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 Totai <br />❑ Cap off, puan ty ❑ Sewer System Development Fee TMaL$_ <br />❑ Reconnection t0 stub ❑ Water Service Line (behind meteq, Size_ <br />❑ Backwater Valve ❑ Backflow Prevention (Outside Building): Q RPBA Q DCVA <br />® NOT REQUIRED ® NOT REQUIRED <br />Explanation/Utility Permit g_ Explanation/Utility Permit N_ <br />IRRIGATION SERVI liver Including Cost Estlmatesf FIRE SERVICE.(Attach Cog Estimate/Requesrjor Reference) <br />® New Connection, Size 3/4-inch ❑ New Connection, Size= Q Per Cost Estimate <br />❑ Meter Only, Size_ ❑ %" Detect Meter Only, Service Size _ <br />® Water System Development Fee Total: $031� 1.00 ❑ Backflow Prevention (Outside Building): O DCDA <br />®Backflow Prevention (Outside Building):®DNA ®NOT REQUIRED <br />❑ NOT REQUIRED Explanation/Utility Permit N_ <br />Explanation/Utility Permit If U23i <br />WATER DEPARTMENT COST ESTIMATE NEEDFPR'W5, PW Reviewer to said cast estimate modest to Water Oeporhnent) <br />❑ Yes, Quantity See attached for reference. <br />NOT REQUIRED <br />Plumi Pnmlrs (Note Permit Technkans to add all Items selected below to Plumbing Permlr for Items inside building only) <br />BaQRow Prevention (inside Building): ❑ DNA(jor Oomestk servim) ❑ RPBA(/or Domestic service) ❑ DCDA Vor Fire service/ <br />NOT REQUIRED <br />BY?MLrg PemVLs (Note: Permit TeMnlcians to add all Items selected below to associated Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />rRAFFIC MTIGATION FEB: <br />❑ YES, ❑ See Attached for calculations /credit <br />❑ YES, Traffic Mitigadpn Total: $_ <br />To be added on PW To be added an <br />❑ See Attached for alculetions/credit <br />Quantity charged Quarmirldimged_SF <br />® NOT REQUIRED <br />_SF <br />QTY is❑Ground only ❑all surfaces CRY Is❑Roof only ❑all surfaces <br />$— <br />NOT REQUIRED <br />MwlINERliRN: <br />ADORES ITTYPE:EISFIR REQUIRED (if yes grew assigned and include) <br />print out AddresULTI-Fs Letter from TRATTOMME <br />CIIALMenu <br />LLDWEss), <br />QMUwItFAMILY []COMMERCIAL <br />❑YES—TYPEDSFR ❑DUPLE% ❑AOU ❑ssueoecopy <br />to <br />❑ See Attached Lacer, 2 copies (Permit to issueonempy to applicant with Permits, scan one ropy to Jeffrey Marks) <br />,Tee&Per <br />❑ Digital copyattachedto permit record Permit p_ <br />Folder <br />❑ Saved to Address Fold¢r 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 p PW <br />❑Stormwater NEEDS Tab Completed in TRAKT ❑ADATab Completetlin TRAKT ❑Inspectons Addedin TRAKT <br />® NOT REQUIRED <br />Worksheet Completed BV:7444e Date:a11112023 <br />Worksheet Reviewed By: SaAera 16dad Date: 05177/2023 <br />