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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> Nom WASHINGTON <br /> PROJECT ADDRESS: 1017 100TH ST SW Permit#: B2112-030 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONSTRUCT NEW SFR, LOT 4 <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 IINater System Development Fee Total: $ 4.:(I•Crt <br /> ❑ Cap-off, quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line (behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> -.NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: µwao.ir> 6 -' Explanation/Utility Permit#: ULioi. -O S <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: $ ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA la-NOT REQUIRED <br /> IS-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 /> lit-NOT 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) 0 RPBA (for Domestic service) ❑ DCDA (for Fire service) <br /> A-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 /> RYES, See Attached for calculations/credit AYES,Traffic Mitigation Total: $3 914.c45 <br /> To be added on PW ZZe4-o2.3 To be added on 0 See Attached for calculations/credit <br /> Quantity charged 2.3(4,( SF Quantity charged SF 0 NOT REQUIRED <br /> QTY is 0 Ground only iai-all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ Ls18•v0 $ <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 /> ICES-TYPE: .SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> Er-See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> KDigital copy attached to permit record, Permit# D3o <br /> .saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES-Type <br /> #OT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> �(ES, Per it# PW L 2ti 4-0 L3. <br /> tormwater NPDES Tab Completed in TRAKiT EirADA Tab Completed in TRAKiT P?4espections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed Date: 41to -7-6Z <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />