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... • • <br /> EVE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4128 RUCKER AVE Permit#: PW2205-017 <br /> TENANT: SAFEWAY <br /> DESCRIPTION OF WORK: CONVERT(3) PARKING SPACES TO(2) EV CHARGING STATIONS <br /> PW Reviewer to select all that apply below: A 0 es -Inn j y nee tut re,vi rw1110 <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, : d 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 System Development Fee Total: $ <br /> ❑ Reconnection to stub ❑ Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building):❑RPBA ❑ DCVA <br /> IN NOT REQUIRED I NOT REQUIRED <br /> Explanation/Utility Permit# Explanation/Utility Permit# <br /> IRRIGATION 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 ❑ 3/4" Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building): ❑DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑DCVA NOT REQUIRED <br /> 9 NOT REQUIRED Explanation/Utility Permit# <br /> Explanation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> 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 /> NOT 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 /> N1 YES, ❑ See Attached for calculations/credit ❑YES,Traffic Mitigation Total: $ <br /> To be added on PW 22.09-011 To be added on ❑See Attached for calculations/credit <br /> Quantity charged 167,$ SF Quantity charged SF VI NOT REQUIRED <br /> QTY is Ground only❑ all surfaces QTY is❑ Roof only❑ all surfaces <br /> $ 41) 01 f? <br /> ❑ 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 /> ❑ 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 Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> ❑ Saved to Address Folder in Development Tech File <br /> 11) inoit LtC. -110 3(2- - <br /> NOT REQUIRED <br /> vort <br /> FIRE SPRINKLERS REQUIRED? poal Lx' µ ( sotlwas.1 O1 <br /> ❑YES—Type t i <br /> NOT REQUIRED " XL1 R'�v� <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> "D7�1 YES, Permit#PW t1 <br /> ormw err NP�ES Tab Completed in TRAKiT Ni ADA Tab Completed in TRAKiT [' Inspections Added in TRAKiT <br /> E I E <br /> Worksheet Completed By: Date: Otgiz3I2a2-1 <br /> WorksheetCompletedBy: � Date: to 123)2-02'2-- <br /> REVISED 12/22/2021 <br />