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• <br /> .. EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> Ems WASHINGTON <br /> PROJECT ADDRESS: 15 SW EVERETT MALL WAY STE K Permit#: B2203-038 <br /> TENANT: NOVEL EYES <br /> DESCRIPTION OF WORK: 2306 SF OFFICE REMODEL TO EYE CLINIC <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 /> O New Connection to main plus connections to building 0 New Connection, Size -0 Per Cost Estimate <br /> • Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑ Cap-off, quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> q Backwater Valve ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> to NOT REQUIRED clf,NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑3/4' Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total:$ 0 Backflow Prevention (Outside Building): CIDCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA K NOT REQUIRED <br /> p.,NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, 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 /> A Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 14 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> ❑ NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ❑ YES, 0 See Attached for calculations/credit BYES,Traffic Mitigation Total: $ Y$s 14(0.0e, <br /> To be added on PW To be added on jSt See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF 0 NOT REQUIRED <br /> QTY is 0 Ground only 0 all hard surfaces QTY is 0 Roof only 0 all hard surfaces Ls.t,A.-�t...*:- 04- 0 S£. <br /> IANOT 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: 0 SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 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# <br /> ❑ Saved to Address Folder in Development Tech File <br /> V NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> ONOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑ YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> PiNOT REQUIRED <br /> Worksheet Completed By• Date: 417 120 22 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />