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EVE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4828 DELAWARE AVE Permit#: B2210-031 <br /> TENANT: <br /> DESCRIPTION OF WORK: Replace Sidewalk(for Basement conversion to ADU) <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 0 New Connection, Size -❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size - 0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total:$ <br /> ❑ Cap-off, quantity 0 Sewer System Development Fee Total. $ <br /> ❑ Reconnection to stub 0 Water S rvice Line (behind meter), Size <br /> ❑ Backwajr Valve 0 Back w Prevention (Outside Building): 0 RPBA or❑ DCVA <br /> SNOT REQUIRED 0 N REQUIRED <br /> Expla ation/Utility Permit# _ Exp nation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑3/4' Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total: $ 0 Backfl Prevention (Outside Building): 0 DCDA <br /> ❑ Backflo revention (Outside Building): ❑ DCVA ONO EQUIRED <br /> ONOT QUIRED Ex anation/Utility Permit#: <br /> Expla�rt'ation/Utility Permit#: <br /> WATER DEP TMENT COST ESTIMATE NEEDED-Ofyes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Qu tity , See attached for reference. <br /> O NOT QUIRED <br /> Plu bing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow revention (Inside Building): 0 DCVA (for Domestic service) 0 RPBA (for Domestic service) ❑ DCDA (for Fire service) <br /> O NOT QUIRED <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 /> O YES, 0 See Attached for calculations/crfdit 0 YES,Traffic Mitigation Total. $ <br /> To be added on PW / To be added on B2210-031 0 See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 639 SF 0 NOT REQUIRED <br /> QTY is ❑ Ground only 0 all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ $_171.12 I <br /> ❑ NOT REQUIRED <br /> Additional Checklists: , <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print o ��• -.s Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE- ❑ SFR ❑ DUPLEX O ADU ❑ INFILL DWELLINe ■ ULTI-FAMILY ❑ COMMERCIAL <br /> O See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> O Digital copy attached to permit record, Permit#B2210-031 <br /> O Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> O NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in RAKiT 0 Inspections Added in TRAKiT <br /> O NOT REQUIRED <br /> Worksheet Comple d By: � __) ate. <br /> Worksheet Che ed By: .-C—N1 V 1/+t( Date- <br /> REVISED 11/27/2019 <br />