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EVE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> MIN WASHINGTON <br /> PROJECT ADDRESS: 620 112TH ST SE SP 17 Permit It:B2311-042 <br /> DESCRIPTION OF WORK: NEW MFH,NEW SIDEWALK,&6'X 10'DECK&4'X 4'DECK <br /> PW Reviewer to select that apply below: <br /> Utility Permits (Note:Perms Technicians to Create Utility Permit for Sewer,W ter,Fire,and Irrigation,as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE:(Attach Calculation&Cost Es <br /> ❑ New Connection to main pl 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 /> D Cap-off,quantity ❑ Sewer System Development Fee Total:$ <br /> ® Reconnection to stub ® Water Service Line(behind meter),Size 3/4" <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building):❑RPBA ❑DC A <br /> ❑ NOT REQUIRED �� (( O1 r _ ❑ NOT REQUIRED <br /> � ?Explanation/Utility Permit <br /> ``_\0` ` 1� Explanation/Utility Permit# Z�O� —O(Co <br /> LIGATION 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 ❑ 'A"De ct Meter Only,Service Size <br /> D Water System Development Fee Total:$ ❑ Bac ow Prevention(Outside Building):❑DCDA <br /> ❑ Ba flow Prevention(Outside Building):❑DCVA ® N REQUIRED <br /> ® N T REQUIRED xplanation/Utility Permit# <br /> xplanation/Utility Permit# <br /> WATER DE RTMENT COST ESTIMATE NEEDED-(/f yes,PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, antity ,See attached for reference. <br /> ® NOT EQUIRED <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 ad all items selected below to ociate Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION F . <br /> ® YES,®See Attached for calculations/ edit ❑YES,Traffic ' ation Total:$0.00 <br /> To be added on PW To be added on B2311-042 ❑Se ttached for calculations/credit <br /> Quantity charged OSF Quantity charged 260SF ® NO QUIRED <br /> QTY is❑Ground only❑all surface QTY is❑Roof only®all surfaces <br /> $0.00 $32.14 <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes n 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 PWClerical@everettwa.gov) <br /> ❑Digital copy attached to permit record,Permit# <br /> ❑Saved to Address Folder in Development Tech File <br /> ® NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> ® NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑ YES,Permit#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> ® NOT REQUIRED <br /> Worksheet Completed By: 7elI1LG P-01.9e dsla Date:11/27/2023 <br /> Worksheet Reviewed By:>44 /deetale Date:11/27/2023 <br />