Laserfiche WebLink
EVERETT <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 9620 & 9702 19TH AVE SE Permit #: PW2202-010 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: SITE WORK FOR GRAYSON SQUARE TOWNHOMES <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 Syst Development Fee Total: $_ <br />ater ice Line (behind meter), Size <br />❑ Reco nection to stub ❑jIa <br />❑ Ba water Valve ow Prevention (Outside Building): ❑RPBA ❑DCVA <br />® TREQUIRED o + 9�•w•�u °L�`"'�' TREQUIRED e.r* "_olanalion/Utility <br />Permit# Eation/Utility Permit # _ <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (AttachCost Estimate/ Request for Reference) <br />❑ New Connection, Size _ ❑New Conne Ion, Size ❑Per Cost Estimate <br />® Meter Only, Size 1 inch ❑ '/." Dete eter Only, Service Size <br />❑ Water System Development Fee Total: $0.00 ❑ Back Prevention (Outside Building): ❑DCDA <br />® Backflow Prevention (Outside Building): ®DCVA ®NO REQUIRED <br />❑ NOT REQUIRED planation/Utility Permit# <br />Explanation/Utility Permit # 4Z2016r <br />ATER DEPARTMENT COST ESTIMATE NEEDED-(/fyes, PW Reviewerto send cost estimate request to Water Department) <br />® Yes, Quantity 1 See attached for reference. <br />❑ NOT REQUI D <br />/umbin ermitS (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building 0 y) <br />Backflow P vention (Inside Building): ❑DCVA (for Domestic service) ❑RPBA (for Domestic service) ❑DCDA (for Fire service) <br />® NOT QUIZ <br />Building Permits (Note: Permit Technic ns to add all items selected below to associated <br />Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FE <br />ITRAFFIC MITI ION FEES: <br />® YES, ® See Attached for calculations / credit <br />YES, Tr c Mitigation Total: $ <br />❑ee <br />To be added on PW 2202-010 To b added on <br />Attached for calculations/credit <br />Quantity charged 123,736 SF Quan ty charged SF <br />® N REQUIRED <br />QTY is ❑ Ground only ® all surfaces QTY' ❑ Roof only ❑ all surfaces <br />$ 33136.50 <br />❑ NOT REQUIRED <br />Additional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br />❑ YES —TYPE: ❑ SFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />❑ See tached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />❑ Digi I copy attached to permit record, Permit #_ <br />❑ Sa ed to Address Folder in Development Tech File <br />® NOT SQUIRED 06+ eu•Lv.. 4 Pta...r�, A zovGv 6,� Gs .� yC oa <br />FIRE SPRINILERSREQUIRED? ` E,yAr�•� foa r55vhN�(c <br />❑ YES —TyI e <br />®NOTRE(�UIRED 0" Bu-wP-�(+ ►fa..•tS <br />Reason: J <br />PUBLIC WORKS PERMIT REQUIRED? <br />® YES, Permit # PW 2202-010 <br />❑ Stormwater NPDES Tab Completed in TRAKiT ❑ ADA Tab Completed in TRAKiT ❑ Inspections Added in T AKiT <br />❑ NOT REQUIRED <br />// I <br />� � A%• �Z 9 <br />Worksheet Completed By: �m e Date: <br />Worksheet Completed By: Date: <br />REVISED 12,22/2021 <br />