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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 815 SIEVERS DUECY BLVD Permit#: PW2103-031 <br /> TENANT: NEW CONST <br /> DESCRIPTION OF WORK: SITE DEV FOR NEW COMMERCIAL TILT UP <br /> PW Reviewer to select all that apply below: <br /> tility 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 t.) <br /> ,r� ew Connection to main plusI connections to building 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 12f-peter Only, Size l" - 0 Per Cost Estimate <br /> ❑ Repair 'Water System Development Fee Total: $ 1 200.00 <br /> ❑ Cap-off, quantity Jil•Sewer System Development Fee Total: $ 3 t : .Od <br /> O Reconnection to stub 0 Water Service Line (behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 c•CVA <br /> NOT REQUIRED ❑ NOT REQUIRED 1 <br /> Explanation/Utility Permit#. ZZ« r 09 Explanation/Utility Permit#: 22r1,` -0l,O <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Es ' e eques or <br /> ❑jJew Connection, Size 0 New Connection, Size ❑ Per Cost Estimate <br /> eter Only, Size 1 �,%" Detect Meter Only, S rvice Size <br /> ,Water System Development Fee Total: $j,2OO.bo 0 Backflow Prevention (0 tside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): DCVA 0 NOT REQUIRED <br /> O NOT REQUIRED ( � - `` 11 �D�l Explanation/Utility Permit#: ... <br /> xplanation/Utility Permit#: \A - ` <br /> W TER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PWReviewerto send cost estimate request to Water Department) <br /> es, Quantity 2. See attached for reference. Fiv E 1a4�`'�Q 3'T <br /> NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items select below to Plumbing Permit- it ms inside building only) <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service RPBA(for Domestic service) XDCDA(for Fire service) <br /> ❑ NOT REQUIRED U.l2. - 0IO4 U 22t)e—Ol2, <br /> Building Permits (Note:Pemmi Technicians to add al/items sel ed below to associated Build' g Pe it) �� / <br /> STORMWATER SYSTEM DEV PMENT FEES: TRAFFIC MITIGATION F' ES: <br /> YES, See Attached for culations/credit ►_ YES, Traffic Mitigatio Total: $I1,So8.ors <br /> To be added on PW 03-031 To be adde n See Attached for, alculations/crec <br /> Quantity charged Col SF Quantity c arged SF 0 NOT REQUIRED , 0 <br /> QTY is❑ Grou only II hard surfaces QTY is Roof only 0 all hard surfaces 1.6i <br /> $ 93.07 $ o <br /> ❑ NOT REQ RED �� <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> RYES—TYPE: 0 SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY riCOMMERCIAL <br /> 5 See 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# $2/03- 044 <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> 'YES-Type t4 f PIA 13 <br /> ❑ NOT REQUIRED <br /> Reason. <br /> PUBLIC�r WORKS PERMIT REQUIR,gD? <br /> I.Q.YES, Per it#PW 2 /03-0 3/ <br /> Stormwater NPDES Tab Completed in TRAKiT fa'ADA Tab Completed in TRAKiT inspections Added in TRAKiT <br /> ❑ NOT EQUIRED <br /> Worksheet Completed By ./ .1 Date: o is*`2.c ZZ <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />