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OL PUBLIC WORKS REVIEW WORKSHEET <br />PROJECT ADDRESS: 2122 106TH ST SW Permit #: C1810-016 <br />TENANT: <br />DESCRIPTION OF WORK: <br />PW Reviewer to select all that <br />[TenName] <br />NEW SFR AND GARAGE <br />below: <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br />SANITARY SEWER: <br />❑ New Connection to main plus connections to building <br />❑ Alteration <br />❑ Repair <br />❑ Cap -off, quantity <br />PrjReconnection to stub <br />❑ Backwater Valve <br />❑ NOT REQUIRED <br />Explanation/ Utility Permit #: <br />IRRIGATION SERVICE: (Not Including Cost Estimates) <br />❑ New Connection, Size <br />❑ Meter Only, Size <br />❑ Water System Development Fee Total: $ <br />❑ Backflow Prevention (Outside Building): ❑ DCVA <br />�;QNOT REQUIRED <br />Explanation/ Utility Permit #: <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />❑ New Connection, Siz - ❑ Per Cost Estimate <br />Meter Only, Size 3 -4 11 Per Cost Estimate <br />❑ Water System Deve opment Fee Total: $ — <br />❑ Sewer System Development Fee Total: $ - <br />❑ Water Service Line (behind meter), Size <br />❑ Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />❑ NOT REQUIRED <br />Explanation/ Utility Permit #: <br />FIRE SERVICE: (Attach Cost Estimate /Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ 1/4" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building): ❑ DCDA <br />NOT REQUIRED <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 />R 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 />KNOT 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, Stormwater Total: $ . , : 5 1. 4 a ❑ YES, Traffic Mitigation Total: $ <br />10 See Attached Spreadsheet for calculations ❑ See Attached Spreadsheet for calculations/credit <br />❑ NOT REQUIRED J4 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 />IX'YES -TYPE: KSFR ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />PELSee 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 />❑ NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES -Type <br />APOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />YES, Permit # PW <br />(X Stormwater NPDES Tab Completed in TRAKiT IA�DA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed BDate: � ZO 19 <br />Worksheet Checked By: (% Date: 05 ¢.om <br />REVISED 212212019 <br />