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0 11, <br /> LE EVERETT <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 10929 10TH DR SE Permit#: B2107-055 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: AFH -PROPOSED 830 SQFT ADDITION AND GARAGE CONVERSION <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 0 New Connection, Size -❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size - 0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑ Cap-off,qu tity 0 Sewer System evelopment Fee Total:$ <br /> ❑ Reconnec' n to stub 0 Water Servi Line(behind meter), Size <br /> ❑Rckwat Valve 0 ackflow P vention (Outside Building): 0 RPBA or 0 DCVA <br /> IOT R QUIRED I NOT R IRED <br /> Explana on/Utility Permit#: Explanat' n/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: ach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Conne on, Size -❑ Per Cost Estimate <br /> ❑Meter Only, S. e 0 3/4" Detec eter Only, Service Size <br /> ❑Water Syste Development Fee Total:$ ❑ :,ckflo Prevention (Outside Building): 0 DCDA <br /> V❑ B ckflow P vention (Outside Building): 0 DCVA ► IOT QUIRED <br /> COT RE IR Expla tion/Utility Permit#: <br /> Explanatio /Uti'y Permit#: <br /> WATER DE RTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> V❑ es, Qt.) tity , See attached for reference. <br /> IOT R QUI D <br /> Plumbin Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> W❑ ackflo Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> IOT QUIRED <br /> /Building Permits (Note:Permit Techni bans to add all items selected bel s ciated Building Perm' <br /> .Sjp2RMW5FER SYSTEM DEVELOPMEN FEES: TRAFFIC MITIG ION FEES: <br /> IIYES, knee Attached for ca culations,/ redit Q G.' ❑YES,Traffi itigation Total: $ <br /> To be added on PW U To be added on Bz d See ached for calculations/credit <br /> Quantity charged Q F Quantity c arged, ,o r. SF "JOT R UIRED <br /> QTY is likGround o ly .I hard s aces QTY ip Roof only ■ . hard surfaces <br /> ❑ N QUIRED <br /> Additional Checklists: I' <br /> ADDRESS LETTE EQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ Se ttached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ D. ital copy attached to permit record, Permit# <br /> ❑ aved to Address Folder in Development Tech File <br /> NOT R UIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> 'N❑ ES—Type <br /> OT REQUIRED <br /> Reason: <br /> P BLIC WORKS PERMIT REQUIRED? <br /> YES, Pe it#PW`2 p --Ni <br /> VStormwater NPD S Tab Completed in TRAKiT ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: '� TE) • ----e—i� Date: �(Z1 Z <br /> Worksheet Checked By: _ ..)5eCA)3Date: 3/a I 202,a <br /> REVISED 11/27/2019 <br />