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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 2713 MAPLE ST Permit#: 62101-051 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONVERT GARAGE INTO DUPLEX <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note.Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and lrngation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br /> ❑ New Connection to main plus connections to building 0 New Connection, Size - 0 Per Cost Estimate <br /> Iteration 0 Meter Only, Size - 0 Per Cost Estimate <br /> Repair 0 Water System Development Fee Total. $ <br /> ❑ Cap-off, quantity ❑ Sewer System Development Fee Total: $ <br /> O0 Reconnection to stub Water Service Line (behind meter), Size 3/4 " <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building) 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED rr 0 NOT REQUIRED /r 2 <br /> Explanation!Utility Permit#: U.7 �l.P 3 Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Conne n, Size - 0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Detec eter Only, Service Size <br /> ❑ Water Sy m Development Fee Total $ 0 Backf Prevention (Outside Building): 0 DCDA <br /> ❑ Backflo Prevention (Outside Building) 0 DCVA -Al REQUIRED <br /> ONOT QUIRED Ex anation!Utility Permit# <br /> Explan tion/Utili Permit# <br /> WATER DEP RTMENT COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Q ntity , See attached for reference <br /> jEkNOT EQUIRED <br /> Plumbing ermits (Note Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflo revention (Inside Building) 0 DCVA (for Domestic service) 0 RPBA (for Domestic service) ❑ DCDA (for Fire service) <br /> ,NOT QUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPME FEES: TRAFFIC MITIGATION FEES: <br /> FLYES, See Attached for calculation credit 01-YES, Traffic Mitigation Total $ -7,ct z-c> <br /> To be added on PW 2Z 1-- To be added on 0 See Attached for calculations/credit <br /> Quantity charged .;co Sv- SF Quantity charged SF 0 NOT REQUIRED <br /> QTY is 0 Ground only 0-all har surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ So 3 4 $ g -ka( <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> LYES-TYPE. 0 SFR DUPLEX 0 ADU 0 INFILL DWELLING 0 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 /> Eh Digital copy attached to permit record, Permit# <br /> u-Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES-Type <br /> Is-NOT REQUIRED <br /> Reason <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> A-YES, Permit# PW 2 2p <br /> -Stormwater NPDES Tab Completed in TRAKiT 4DA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By Date �/Z S /�..2-2- <br /> Worksheet Checked By. Date <br /> REVISED 7 t,2 7/2019 <br />