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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 1728 100TH ST SW Permit #: B2207-089 <br />DESCRIPTION OF WORK: NEW SFR & DRIVEWAY - LOT C, EAST HOUSE <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 3/4" - ❑ Per Cost Estimate <br />❑ Alteration ❑ Meter Only, Size - ❑ Per Cost Estimate <br />❑ Repair ® Water System Development Fee Total: $4,311.00 <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 # )C 4- <br />Explanation/Utility Permit MWWD _U31, <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 ❑ 3/," Detect Meter Only, Service Size <br />❑ 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 <br />Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />TRAFFIC MITIGATION FEES: <br />f4 YES, ❑ See Attached for calculations / credit <br />® YES, Traffic Mitigation Total: $4993.00 <br />To be added on PW To be ed o <br />❑See Attached for calculations/credit <br />Quantity charged '"SF Qu ity c ed ,SF <br />❑ NOT REQUIRED <br />QTY is and only ® all surfaces Y is Roo ly ❑ all surfaces <br />Q Gr <br />$ t t ,5 Iroof44'u d ovi <br />0AkLRrWTRF-D <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 #B2207-089 <br />® Saved to Address Folder in Development Tech File <br />❑ NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />—Type <br />®YES <br />NOT REQUIRED <br />JJ <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />® YES, Permit # PW2207-023 <br />❑ Stormwater NPDES Tab Completed in TRAKiT ❑ ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Q <br />Worksheet Completed By: �/irs! �. Date: 02/28/2023 <br />Worksheet Completed By: Date: <br />REVISED 1010712022 <br />