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EVERETT • IP <br /> WASHINGTON PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 2912 WETMORE AVE Permit#: B2404-026 <br /> DESCRIPTION OF WORK: NEW PRE-FAB CMU SIDEWALK RESTROOM <br /> PW Reviewer to select all that apply below: <br /> /•tility Permits (Note:Permit Technicians to Create Utility mit for Sewer, ter,Fire,and Irrigation,as selected below) <br /> /SANITARY SEWER: DOMESTIC WATER SERVICE:(Attach Calculation&Cost Es .) <br /> ® New Connection to main plus 1 connections to building ® New Connection,Size 1-inch- 0 Per Cost Estimate/ <br /> El Alteration ❑ Meter Only,Size -❑Per Cost Estimate <br /> El Repair ® Water System Development Fee Total:$7,644.00 / <br /> • Cap-off,quantity ® Sewer System Development Fee Total:$6,727.00✓ <br /> ❑ Reconnection to stub <br /> El <br /> Valve ® Backflow Prevention(Outside Building):El RPBA DC 'A <br /> NOT REQUIRED ❑ NOT REQUIRED l <br /> \\ I <br /> Explanation/Utility Permit#A�� -0 1 r�►-�'� Explanation/Utility Permit# Z"C05 <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) RE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size' ❑ New Connection,Size -❑ Per Cost Estimate <br /> ❑ M• eter Onl Size ❑ %"Dete t Meter Only,Service Size <br /> El W• ater; stem Development Fee Total:$ ❑ Bac ow Prevention(Outside Building):El DCDA <br /> ❑ Ba,- ow Prevention(Outside Building):❑DCVA ® T REQUIRED <br /> ►/ 'OT REQUIRED Explanation/Utility Permit# <br /> Explanation/Utility Permit# <br /> WATER DEPART ENT COST ESTIMATE NEEDED-(If yes,PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes,Qu ity ,See attached for reference. <br /> ® NOT QUIRED <br /> Plumbing Per its(Note:Permit Technicians to add all items selected below to Plumbing Permit for items inside building only) <br /> Backflow evention(Inside Building): El DCVA(for Domestic service) El RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> ® N 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,El See Attached for calculations/credit El YES,Traffic Mitigation Total:$ <br /> To be added on PW To be added on ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF ® NOT REQUIRED - <br /> QTY is • :round only❑all surfaces QTY is❑Roof only❑all surfaces <br /> $ $ <br /> ® No REQUIRED <br /> A,•itional 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 ❑AD ❑ 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 PWClerical@everettwa.gov) <br /> ®Digital copy attached to permit record,Permit#B2404-026 <br /> ®Saved to Address Folder in Development Tech File <br /> El NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> El YES—Type <br /> ® NOT QUIRED <br /> R son: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ® YES,Permit#PWPW2404-064 <br /> ®Stormwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRAKiT ® Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: 'MeleeVezeizart Date:04129912024 <br /> Worksheet Reviewed By:,44 4e9afe , Date:0412912024 <br />