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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 1505 112TH ST SW Permit #: B2012-005 <br />TENANT: UNITED METHODIST CHURCH <br />DESCRIPTION OF WORK: REMODEL EXTG VEHICLE EMISSIONS TEST BLDG INTO A CHURCH <br />PW Reviewer to select all that aDDly below: <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br />SANITARY SEWER: <br />❑ New Connection to main plus connections to building <br />❑ Alteration <br />❑ Repair <br />❑ Cap -off, qu tit <br />El Re( on to stub <br />❑ Backw er Valve <br />M NOT EQUIRED <br />Expla ation/ Utility Permit #: <br />(Not Including Cost Estimates) <br />❑ New Connecti , Size <br />❑ M/Sem <br />lize <br />❑ WDevelopment Fee Total: $ <br />❑ Bventio (Outside Building): <br />0 NEDEXoIi Permit #: <br />❑ DCVA <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size - ❑ Per Cost Estimate <br />❑ Water System D velopment Fee Total: $ <br />❑ Sewer Syste evelopment Fee Total: $ <br />❑ Water Se ce Line (behind meter), Size <br />❑ Backfl Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />IN NO EQUIRED <br />Explanation/ Utility Permit #: <br />FIXwPrevention <br />tach Cost Estimate /Request for Reference) <br />❑ ion, Size - ❑ Per Cost Estimate <br />❑ ter Only, Service Size <br />❑ ention (Outside Building): ❑ DCDA <br />N EDExity Permit #. <br />WATER DEPARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, Q on it <br />See attached for reference. <br />till NOT QUIRE <br />PlumbingZver <br />rmits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />❑ Backflow tion (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />M NOT 711UIRED <br />wilding Permits (Note. Permit Technicians to add all ite s selected below to sociated Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATIO ES: <br />14 YES, 0 See Attached for calculations / credit YES, Traffic Miti ion Total: $ <br />To be added on PW 2101-019 To e added on ❑ See Atta ed for calculations / credit <br />Quantity charged 477 SF uantity charged SF NOT REQ ED <br />QTY is �l Ground only ❑ all hard surface QTY is ❑ Roof only ❑ all hard surfaces <br />$ 125.59 $ <br />T REQUIRED <br />Additional Checklists: <br />ADDRESS LETTER QUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />❑ YES — TYPE: ❑ R ❑ DUPLEX ❑ ADU [IINFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />❑ See ached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />❑ Dig' I copy attached to permit record, Permit # <br />❑ S ed to Address Folder in Development Tech File <br />D4 NOT RE UIRED <br />FIRE SPRINKLEJM REQUIRED? <br />❑ YES —Type <br />DI NOT RE( IRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />W YES, eermit # PW 2101-019 <br />4 Stormwater NPDES Tab Completed in TRAKiT 'ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: AH Date: 3/30/21 <br />Worksheet Checked By: �G�� L✓ O Date: 03 !30 , z-C C—L <br />REVISED 1112712019 <br />