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EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3430 NORTON AVE Permit#: B2107-048 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONSTRUCT ACCESSORY DWELLING UNIT <br /> PW Reviewer to select all that apply below: <br /> tility Permits (Note:Permit Technicians to Crea e ' Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation & Cost t.) <br /> ❑pew Connection to main plus connections to building 0 New Connection, Size - 0 Per Cost Estimate <br /> Alteration 0 Meter Only, Size - 0 Per Cost Estimate <br /> O Repair 0 Water System Development Fee Total: $ <br /> O Cap-off, quantity ❑ ewerf System Development Fee Total: $ !/ <br /> ❑ Reconnection to stub ater Service Line (behind meter), Size <br /> Backwater Valve 0 Backflow Prevention (Outside Building). 0 RP A or 0 DCVA <br /> ❑ NOT REQUIRED (( iD�C ❑ NOT REQUIRED <br /> Explanation/Utility Permit#: a,Z ZO\ \ planation/Utility Permit#. " 2_, <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: Attach Cost Estimate/Request for Ref rence) <br /> D New Connecti. , Size ❑ New Conne. on, Size - 0 Per Cost Estimate <br /> ❑ Meter Only :ize ❑'A" Dete ' eter Only, Service Size <br /> ❑ Water Sy: em Development Fee Total: $ 0 ackfl• - Prevention (Outside Building): 0 DCDA <br /> ❑ lackfl., Prevention (Outside Building): 0 DCVA VO "EQUIRED <br /> NO -'EQUIRED Ex. .nation/Utility Permit#. <br /> Expl•'ation/Utility Permit#: <br /> WATER D ARTMENT COST ESTIMATE NEEDED-(If yes, PWReviewerto send cost estimate request to Water Department) <br /> 0/Yes, antity , See attached for reference <br /> ISX NO REQUI' D <br /> PI mbin. "Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ ackfl• Prevention (Inside Building): 0 DCVA (for Domestic service) 0 RPBA (for Domestic service) 0 DCDA(for Fire service) <br /> OT 'EQUIRED <br /> Building <br /> PermitsR SSTEMNDEVELOPIt Technicians MENT FEES:to add all items selected low associated <br /> TRAF�Crlding MITIGAT OPermit) <br /> �FEES: <br /> YES, ❑ See Attached for calculations/credit ff��,, ❑YES,Traffic Mi ' ation Total: $ <br /> To be added on PW To be added on —d�f ❑ See Att ed for calculations/credit <br /> Quantity charged SF Quantity charged SF NOT RE IRED <br /> QTY is ❑ Ground only❑ all hard surfaces QTY is Roof ly ❑all and surfaces <br /> $ $ �75, <br /> NOT REQUIRED <br /> Additional Checklists: <br /> AQDRESS LETTER REQUIRED? (If yes ( w assigned address), print out Addre Letter from TRAKiT Print Menu and include) <br /> YES—TyPE: 0 SFR 0 DUPLEX VDU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> gi ee Attached Letter,2 copies (Permit Techs to is ue one c py to applicant with permits, scan one copy to Jeffrey Marks) <br /> CIV gital copy attached to permit record, Permit# 710 ©'-I <br /> aved to Address Folder in Development Tech Fife <br /> ❑ NOT R QUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> VOS—Type <br /> T REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> KNOT REQUIRED e-) . `� <br /> Worksheet Completed By: T , Date: [2 17 �2 <br /> ,- --- . /Z— ZO Za ZI <br /> Worksheet Checked By: � ��� Gam- � Date: <br /> i <br /> REVISED 11/27/2019 <br />