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E V E R E T T <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 1730 100TH ST SW Permit #: B2207-090 <br />DESCRIPTION OF WORK: NEW SFR & DRIVEWAY - LOT C, WEST 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 # MWWD Explanation/Utility Permit # ;) Z3 G3 �' 13 <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 ❑ 3W' 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-(Ifyes, 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 />d for calculations / credi <br />YES, ❑ See Attach&SFF <br />® YES, Traffic Mitigation Total: $4993.00 <br />To be added on PW�'QL!J To b d o <br />❑See Attached for calculations/credit <br />Quantity charged 4 Q ntit SF <br />❑ NOT REQUIRED <br />QTY is ❑ Ground only gall surfaces Tys Ro f only ❑ all s rfaces <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 #6227-090 <br />® Saved to Address Folder in Development Tech File <br />❑ NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type <br />® NOT REQUIRED A � Reason: WWI <br />'����� t I/ (i <br />1 <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 />Worksheet Completed By: ��'^� Date: 02/28/2023 <br />Worksheet Completed By: Date: <br />REVISED 1010712022 <br />