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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 9 74TH ST SW Permit#: B1910-042 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW DETACHED 22X2711 1.2" POLE BLDG GARAGE <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 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 /> ❑ Backwater Valve Cl Backflow Prevention (Outside Building): ❑ RPBA or 0 Pr-NOT REQUIRED KNOT 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 0 3/4' Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA 15l.NOT REQUIRED <br /> SNOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> FOOT 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): 0 DCVA(for Domestic service) ❑ RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> Jr IOT 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 /> FLYES, Stormwater Total: $ ,3 O -1.3 `! ❑YES,Traffic Mitigation Total: $ <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit <br /> E All Hard Surface Fees to be added to Permit# tch 2• 0.2 4 KNOT REQUIRED <br /> ❑ See Attached Spreadsheet for calculations/credit <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: 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 /> et NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> ,J-NOT REQUIRED <br /> Reason: <br /> PyBLIC WORKS PERMIT REQUIRED? <br /> Jb-YES, Permit#PW 19 1 2 - 0 2 9 <br /> -Stormwater NPDES Tab Completed in TRAKiT O'1DA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By`" >� Date: l2 I t(c /Zo <br /> Worksheet Checked By: Act, Date: -z4(6 (iI9 <br /> REVISED I1/27/2019 <br />