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`EVERETT PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 1730100TH ST SW Permit#: B2207-09D <br />DESCRIPTION OF WORK: NEW SFR S DRIVEWAY -LOT C, WEST HOUSE <br />PIN Reviewer to select all Mat apply below: <br />U#Illy Plural (Note: Permd Technicians 0 Create UMky Paper for Sewer, Water, Fire, and mallow, as selected below) <br />SANITARY SEWER: DOMESTIC WATER SERVICE: (Agech Calculation 8 Cost Ed.) <br />New Connection W 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 -of, 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 />FxplanationllIDlity Permit # MWWD Explanation/Utility Permit # <br />IRRIGATION SERVICE (Not Including Cost Estimates) FIRE SERVICE.(Aflach Cost Estimate/ Request lor Relevance) <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-(ffyes, 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 Pemllt-for dems made building only) <br />Beckflow Prevention (Inside Builditgf: ODCVA(ror Domestkservica) QRPBA(i rpomesb'csarvice) QDCDAphr Fisservire) <br />NOT REQUIRED <br />Building Permits (Note: Permit Technicians ho add all items salectedbelow to assoclated <br />BuiMirg Perm#) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />RAFFIC MITIGATION FEES: <br />❑ YES, 0 See Attached for caioulabons I credit <br />V3 YES, Trefflc Mitigation Tobi $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 />® See Attached Lefler, 2 copies (Permit Techs to issue one cuoyho applicant with permits, scan one cvpym Jeffrey Marks) <br />® Digital copy almhed to permit mmi Petmit#B227-090 <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 # PW22U7-023 <br />❑ Stwmwffier NPDES Tab Completed in TR T ❑ ADA Tab Completed In TRAWT ❑ Inspections Added in TRAKIT <br />O NOT REQUIRED <br />Wortsheetcompleted By: iF'�'a Date: 02/28/2023 <br />Worksheet Completed By: Data <br />REMrs ran7402: <br />