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EVE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 620 112TH ST SE#178 Permit if: B2104-055 <br /> DESCRIPTION OF WORK: NEW MANUF HOME IN EXTG MANUF HOME PARK W/STEPS&DECK <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 /> ❑ Repair ❑ Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity ❑ Sewer System Development Fee Total:$ <br /> ® Reconnection to stub ® Water Service Line(behind meter),Size <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building): ❑RPBA ❑DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED <br /> Explanation/Utility Permit# J - 013 Explanation/Utility Permit# V 1-305 •U LS <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size ❑ New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> E Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building):❑DCDA <br /> ❑ Backflow Prevention(Outside Building):❑DCVA ® NOT REQUIRED <br /> ® NOT REQUIRED Explanation/Utility Permit# <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 /> ® 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 fef calculations/credit \ 1 / ❑ YES,Traffic Mitigation Total:$ <br /> To bead d o To is,added on 4-055 ❑See Attached for calculations/credit <br /> Quant. a ed SF Quantity ed 1458SF ® NOT REQUIRED <br /> Q is❑Grountl•Qny❑all surfaces QTY Ro my❑all sur V <br /> �� 0.45 <br /> cleN-OT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address),print out Address Letter from TRAKiT Print Menu and include) <br /> ® YES—TYPE:®SFR ❑DUPLEX ❑ADU ❑INFILL DWELLING ❑MULTI-FAMILY ❑COMMERCIAL <br /> ®See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits,scan one copy to Jeffrey Marks) <br /> ®Digital copy attached to permit record,Permit# B2104-055 <br /> ®Saved to Address Folder 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#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKIT <br /> ® NOT REQUIRED <br /> Worksheet Completed By: /41.4.411/4 7'PJLGt441 Date: 0510812025 <br /> Worksheet Reviewed By: ,., % Date: 05/0991,VOd3"' 51IIOI?A23 <br />