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EVERETT PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 9612 19TH AVE SE UNIT C Permit M B2207-066 <br />TENANT: GRAYSON SQUARE TOWNHOMES BLDG L <br />DESCRIPTION OF WORK: NEW TOWNHOUSE - GRAYSON SQUARE BLDG L <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 />New Connection to main plus connections to building <br />❑ Alteration <br />❑ Repair <br />❑ Cap -off, quantity <br />❑ Reconnection to stub <br />❑ Backwater Valve <br />❑ NOT REQUIRED <br />Explanation/Utility Permit # <br />1GATION SERVICE: (Not Including Cost Estimates) <br />New Connection, Size <br />Meter Only, Size <br />Water System Development Fee Total- <br />Backflow Prevention (Outside Building): ❑DCVA <br />NOT REQUIRED <br />Explanation/Utility Permit # <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />gMeter Only, Size '�� - ❑ Per Cost EstimAte <br />Water System Development Fee Total $ <br />❑ Sewer System Development Fee Total: $ & <br />❑ Water Service Line (behind meter), Size <br />❑ Backflow Prevention (Outside Building)- ❑RPBA ❑ DCVA <br />❑ NOT REQUIRED <br />Explanation/Utility Permit <br />FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ %" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building): ❑DCDA <br />(] NOT REQUIRED <br />Explanation/Utility Permit # <br />WATER DEPARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, Quantity , See attached for reference <br />F-1 NOT REQUIRED <br />Plumbing Permits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />Backflow Prevention (Inside Building) ❑DCVA (for Domestic service) ❑RPBA (for Domestic service) ❑DCDA (for Fire service) <br />NOT REQUIRED <br />Building Permits (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br />❑ YES, ❑ See Attached for calculations / credit ❑ YES, Traffic Mitigation Total: $ <br />To be added on PW To be added on ❑See Attached for calculations/credit <br />Quantity charged SF Quantity charged SF NOT REQUIRED <br />QTY is ❑ Ground only ❑ all surfaces QTY is ❑ Roof only ❑ all surfaces <br />6d NOT REQUIRED a,� AUA,IrGIA An -Vm-npryY* k <br />dditional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />YES — TYPE: V SFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />See Attached Letter, 2 copies (Permit Techs to issap one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />Digital copy attached to permit record, Permit # 1-0 (o <br />Saved to Address Folder in Development Tech File <br />❑ NOT REQUIRED <br />FIRE SPRINKLERS <br />0 YES —Type <br />❑ NOT REQUIRED <br />Reason <br />PUBLIC WORKS PERMIT REQUIRED? <br />YES, Permit # PW_114 -() 10 <br />❑ Stormwater NPDES Tab Completed in TRAKiT <br />I —I NOT REQUIRED <br />❑ ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />Worksheet Completed By ( -T <br />Worksheet Completed By. <br />Date: -I w ht-n- <br />Date: <br />REVISED 12/22/2021 <br />