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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1019 100TH ST SW Permit#: B2112-031 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONSTRUCT NEW SFR, LOT 3 <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 ❑ New Connection, Size - ❑ Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only, Size - ❑ Per Cost Estimate <br /> ❑ Repair [off--Water System Development Fee Total: $ 4-.31+.c- <br /> ❑ Cap-off, quantity ❑ Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub ❑ Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ Backflow Prevention (Outside Building): ❑RPBA El DCVA <br /> .NOT REQUIRED ❑ NOT REQUIRED <br /> Explanation/Utility Permit# 4.0kke.cw7 5-f-N...L.c.. Explanation/Utility Permit# U Zoc9-634 <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size El New Connection, Size - ❑ Per Cost Estimate <br /> ❑ Meter Only, Size ❑ 34 Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): ❑DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑DCVA Z--NOT cg_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 /> li...f\lOT 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): ❑DCVA (for Domestic service) ❑RPBA (for Domestic service) ❑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, [A-See Attached for calculations/credit [ -YES, Traffic Mitigation Total: $3,44 4•oa <br /> To be added on PWZ ZoL-024 To be added on ❑See Attached for calculations/credit <br /> Quantity charged ;iti$SF Quantity charged SF ❑ NOT REQUIRED <br /> QTY is ❑ Ground only Zall surfaces QTY is ❑ Roof only ❑ all surfaces <br /> $ [a?8,vo <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 /> Y---YES-TYPE: [/73f-R ❑ DUPLEX ❑ADU El INFILL DWELLING El MULTI-FAMILY El 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#SI M M 2-0 31 <br /> 21-Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES-Type <br /> cgLNOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> X.yES, Permit# PW 2'Lo 4•oLS- <br /> ,S.tormwater NPDES Tab Completed in TRAKiT LDA Tab Completed in TRAKiT 2144aspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: 4 4 Ito /oZZ- <br /> Worksheet Completed By: Date: <br /> REVISED 12/22/2027 <br />