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`EVERETT PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 1728100TH ST SW Permit#: B2207489 <br />DESCRIPTION OF WORK: NEW SFR B DRIVEWAY -LOT C, EAST HOUSE <br />PIN Reviewer to select all Mat apply below: <br />U#Illy Papal (Note: Permd Technicians d Create UMlty Padget for Sewer, Water, Fire, and lmgation, as sell below) <br />SANITARY SEWER: DOMESTIC WATER SERVICE: (Agech Calculation 8 Cost Ed.) <br />New Connection to main plus _ connections W building ® New Connection, Size 3W - 0 Per Cost Estimate <br />❑ Alteration ❑ Meter Only, Size= 0 Per Cost Estimate <br />Repair ® Water System Development Fee Total: 34.31100 <br />Cap -off, quantity ❑ Sewer System Development Fee Total: $ <br />0 Reconnection to stub 0 Water Service Line (behind motor), Size <br />Backwater Valve ❑ Backfiow Prevention (Outside Building): ORPBA 0DCVA <br />® NOT REQUIRED 0 NOT REQUIRED <br />Fxplanationl1101ity Permit # MWWD Explanation/Utility Permit # <br />IRRIGATION SERVICE (Not Including Cost Estimates) FIRE SERVICE.(Aflach Cost Estimate/ Request lor Reference) <br />New Connection, Size _ ❑ New Connection, Size= 0 Per Cost Estimate <br />Meter Only, Size _ 3W Detect Meter Only, Service Size _ <br />Water System Development Fee Total: $_ ❑ Backfiow Prevention (Outside Building): ODGDA <br />❑ Beckflow Prevention (Outside Building) ODCVA ® NOT REQUIRED <br />® NOT REQUIRED Explanation/Utility Permit # <br />ExplanationAblity Permit # <br />WATER DEPARTMENT COST ESTIMATE NEEDED-(gyes, PW Reviewer to send cost estimate request to Water Department) <br />Yes, Quantity _, See attached for reference. <br />® NOT REQUIRED <br />Plumbing Pascal (Note: Permit Technicians to add all items selected below to Plumbing PemtR-for items made building only) <br />Beckflow Prevention (Inside Building): ODCVA(ror Domesfcsanica) QRPBA(i rpomesb'csarvice) QDCDAter Fissimire) <br />NOT REQUIRED <br />Building rental (Note: Permit Technicians to add all items salectedbalow to assoclated <br />B iong Perm#) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />RAFFIC MITIGATION FEES: <br />❑ YES, 0 See Attached for caioulabons I credit <br />V3 YES, Trefflc Mitigation Total: $4993.00 <br />To be added on PW_ To be added on <br />[]&a Attached for calculationsrcredit <br />Quantity charged —BE Quantity charged _SF <br />NOT REQUIRED <br />QTY is 0 Ground only 0 all surfaces QTY is 0 Root only 0 all surfaces <br />NOT REQUIRED <br />Additional Checklists: <br />ADDRESS LETTER REQUIREDT (If yes (new assigned address), print out Address Lefler from TRAIGT Print Menu and include) <br />®YES —TYPE: ®SFR []DUPLEX ❑ADu ❑ INFILL DWELLING []MULTI -FAMILY ❑COMMERCIAL <br />® Sea Attached Lefler, 2 copies (Permit Term to issue one copyto applicant with permits, scan one col Jeffrey Merles) <br />® Digital copy attached to permit recoN, Petmit#B2207-099 <br />® Saved to Address Folder in Development Tech File <br />NOT REQUIRED <br />FIRE PRINKLN ERA Il REDi <br />�f VE5—Type <br />® NOT REQUIRED <br />Reason: <br />P BLV W RK PERMIT REi IRED7 <br />VES. Permit # PW22UT-023 <br />❑ Stom¢vffier NPDES Tab Completed in TR T ❑ ADA Tab Completed In TRAK7 ❑ Inspections Added in TRAKT <br />0 NOT REQUIRED g /J <br />WortsheetcompleteiBy: Date: 02/28/2023 <br />Worksheet Completed By: Data <br />REMrs ranm02: <br />