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• <br /> .■ E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 6900 WETMORE AVE Permit#: B2204-035 <br /> TENANT: SEATTLE BETHANY CHURCH <br /> DESCRIPTION OF WORK: 18,350 SF CHRUCH TENANT IMPROVEMENT TO EXTG SHELL STRUCTURE, <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 ❑ Water System Development Fee Total: $ <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 ❑ DCVA <br /> E NOT REQUIRED E 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 ❑ New Connection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only,Size ❑ 3/ Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): ❑DCDA <br /> ❑ Backflow Prevention(Outside Building): ❑DCVA E NOT REQUIRED <br /> E 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 /> E 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): ❑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 /> E YES, E See Attached for calculations/credit ❑YES,Traffic Mitigation Total:$ <br /> To be added on PW2205-026 To be added on ❑See Attached for calculations/credit <br /> Quantity charged 1,191SF Quantity charged SF E NOT REQUIRED <br /> QTY is E Ground only❑ all surfaces QTY is❑ Roof only❑ all surfaces <br /> $318.95 <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: ❑ SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ 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 /> E NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> E NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> E YES, Permit#P1N2205-026 <br /> E Stormwater NPDES Tab Completed in TRAKiT E ADA Tab Completed in TRAKiT E Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: <br /> v 5'/Z4314-4) <br /> Worksheet Completed By: Date: <br /> REVISED 12/22/2021 <br />