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0 0 <br /> EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1318 75TH ST SE Permit#: B2201-048 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW SFR <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit 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 1 inch -® Per Cost Estimate <br /> ❑ Alteration Meter Only,Size -❑ Per Cost Estimate <br /> ❑ Repair ® Water System Development Fee Total:$2889.00 <br /> ❑ Cap-off,quantity ® Sewer System Development Fee Total: $ 3,738.00 <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# l 2? .•ck Explanation/Utility Permit# `o%—00' \- <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVI E: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connecti , Size ❑ New C nnection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, ize ❑ 3/" D tect Meter Only, Service Size <br /> ❑ Water Sy em Development Fee Total:$ ❑ B flow Prevention (Outside Building): ❑DCDA <br /> ❑ Backfl Prevention(Outside Building): ❑DCVA ® T REQUIRED <br /> ® NOT EQUIRED Explanation/Utility Permit# <br /> E anation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ® Yes, Quantity 1 , See attached for reference. <br /> ❑ NOT REQUIRED <br /> \Plumbi• • Permits(Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Backflo Prevention (Inside Building): ❑DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> ® No. REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selecte elow to associated Building P rmit) <br /> STORMWATER SYSTEM DEVELOPMENTS: ffi <br /> TRAFFIC IGATION FEES: <br /> El YES,YES, See Attached for calculations/ redit ❑YES, rac Mitigation Total: $ <br /> To be added on PW To be added on B2201-048 See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 1845 SF ® T REQUIRED <br /> QTY is❑ Ground only❑ all surfaces QTY is® Roof only❑ all surfaces <br /> $ $494.09 <br /> ❑ NOT REQUIRED <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# B2201-048 <br /> ® Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> ® NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ® YES, Permit#PW 2201-015 <br /> ® Stormwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRAKiT ® Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED - ^ <br /> Worksheet Completed By: �4 it /SePi r Date: 0 6- ?3- 2c7 2 2 <br /> Worksheet Completed By: Date: <br /> REVISED 12/22/2021 <br />