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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 2611 ROCKEFELLER AVE Permit#: PW2101-023 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITEWORK FOR NEW MULTI-FAMILY BUILDING-ROCKEFELLER SQUARE 2 <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 /> gNew Connection to main plus a connections to building :New Connection, Size Z. -0 Per Cost Estimate 2Q22- <br /> t7 p <br /> Alteration Meter Only, Size -0 Per Cost E timate <br /> ❑ Repair IIB'Water System Development Fee Total: $ 1."(a2 •cro ,c,o 4(,.a <br /> ❑ Cap-off, quantity B-Sewer System Development Fee Total: $ 12, 0.34..oo 12,q 44,e <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 t 0 NOT REQUIRED <br /> xplanation/Utility Permit#: ZZCS\ 002 Explanation/Utility Permit#: 2�� �� <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) / FIRE SERVICE: (Attach Cost Estimate/Request for Reference <br /> ❑ New Connection, Size p-New Connection, Size 1 - -la Per Cost Estimate <br /> ❑ Meter Only, Size EI--%" Detect Meter Only, Service Size ' <br /> ❑ e opm - - 0 Backflow Prevention (Outside Building): 0 DCDA <br /> Backflow Prevention (Outside Building): ELDCVA 0 NOT REQUIRED <br /> ❑ NOT REQUIRED tcy, xplanation/Utility Permit#: <br /> CC�J <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department <br /> Ii--Yes, Quantity `. , See attached for reference. 4'' ,Fz` �Lv,r--C •-4 n►tc--r•c...) <br /> T REQUIRED --- <br /> Plumbing Permits (Note:Penn! chnicians to add all items selecte below to Plumbing Permit-for ite 'nside building only) <br /> IS Backflow Prevention (Inside Building : EI-DCVA(for Domestic service) RPBA(for Domestic service) DCDA(for Fire service) <br /> ❑ NOT REQUIRED u 22Ot ,-CO <br /> Building Permits (Note:Pennit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DTAELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> 0/1-YES, 0 See Attached f calculations/credit (Y-YE ,Traffic Mitigation Total: $ <br /> To be added on PW / I- 02_3 To be added on Q-S"ee Attached for calculations/credit <br /> Quantity charged 't SF Quantity charged SF 0 NOT REQUIRED �� <br /> QTY is 0 Grou only all hard surfaces QTY is 0 Roof only 0 all hard surfaces at) �1, <br /> $ q 2 c'+4. 53$ <br /> ❑ NOT REQU D 2_,o2 z : r1r o q4,as <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: 0 SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING MULTI-FAMILY 0 COMMERCIAL <br /> ® See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> I Digital copy attached to permit record, Permit# t 2 Jo 1-0 2-3 <br /> IZ' Saved to Address Folder in Development Tech File <br /> ❑ REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> 6-YES-Type r-1 F r-► .•Ii <br /> ❑ NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> 0-YES, Permit#PW 2,oi- 013 <br /> plStormwater NPDES Tab Completed in TRAKiT ,01-ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: /2. /2/ JZou <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />