1023 100TH ST SW 2024-08-07 - Laserfiche WebLink

E V E R E T T PUBLIC WORKS REVIEW WORKSHEET NOM WASHINGTON PROJECT ADDRESS: 1023 100TH ST SW Permit#: PW2204-022 TENANT: [TenName] DESCRIPTION OF WORK: SITE WORK FOR NEW SFR PW Reviewer to select all that apply below: Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) 0-New Connection to main plus connections to building ❑ New Connection, Size - ❑ Per Cost Estimate ❑ Alteration ❑ Meter Only, Size - ❑ Per Cost Estimate ❑ Repair ❑ Water System Development Fee Total: $ ❑ Cap-off, quantity ❑ Sewer System Development Fee Total: $ ❑ Reconnection to stub ❑ Water Service Line(behind meter), Size Init Backwater Valve ❑ Backflow Prevention (Outside Building): ❑RPBA ❑ DCVA 511 NOT REQUIRED E NOT REQUIRED ,NCA, tf. A Explanation/Utility Permit# n r s� G t - xplanation/Utility Permit# Cc. £.i 'NA Cre _ IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) ❑ New Connection, Size ❑ New Connection, Size - ❑ Per Cost Estimate ❑ Meter Only, Size ❑ 3/4" Detect Meter Only, Service Size ❑ Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): EDCDA ❑ Backflow Prevention (Outside Building): ❑DCVA [ -NOT REQUIRED g NOT REQUIRED Explanation/Utility Permit# Explanation/Utility Permit# WATER DEPARTMENT COST ESTIMATE NEEDED-(Ifyes, PW Reviewer to send cost estimate request to Water Department) ❑ Yes, Quantity , See attached for reference. IOT REQUIRED Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) Backflow Prevention (Inside Building): ❑DCVA (for Domestic service) ❑RPBA (for Domestic service) ❑DCDA (for Fire service) [ -NOT REQUIRED Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: 11*-YES,0-See Attached for calculations/credit ❑YES, Traffic Mitigation Total: $ To be added on PW 2204-o ZZ To be added on ❑See Attached for calculations/credit Quantity charged iv31SF Quantity charged SF -NOT REQUIRED QTY is ❑ Ground only[gall surfaces QTY is ❑ Roof only ❑ all surfaces c .s • ,E.4b 1 •6(-1c1- $ ft?53•vti ❑ NOT REQUIRED Additional Checklists: ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) ( -YES-TYPE: [ SFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL ZSee Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) [�Digital copy attached to permit record, Permit#132112.- a33 waved to Address Folder in Development Tech File ❑ NOT REQUIRED FIRE SPRINKLERS REQUIRED? YES-Type NOT REQUIRED Reason: FAJBLIC WORKS PERMIT REQUIRED? -YES, Permit# PW 2Zo 4-o Z-- g-s-tormwater NPDES Tab Completed in TRAKiT g-ADA Tab Completed in TRAKiT `inspections Added in TRAKiT ❑ NOT REQUIRED Worksheet Completed Date: 4.1 Zo 11.c2Z Worksheet Completed By: Date: REVISED 12/22/2021