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RE E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1422 RUCKER AVE Permit#: C2007-009 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: 144 SF ADDITION AND REMODEL TO EXISTING KITCHEN <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 - 0 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 S stem Development Fee Total: $ <br /> ❑ Reconnec' n to stub 0 Water rvice Line(behind meter), Size <br /> Backwa r Valve Back w Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> IIINNOT QUIRED REQUIRED <br /> xplana on/Utility Permit# xplanation/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 nly, Size 0 3/4" Det ct Meter Only, Service Size <br /> ❑Water ystem Development Fee Total. $ 0 Back w Prevention (Outside Building): 0 DCDA <br /> ❑ Back w Prevention (Outside Building): 0 DCVA NO REQUIRED <br /> NO REQUIRED xpl ation/Utility Permit#. <br /> xpla ation/Utility Permit#: <br /> WATER DE ARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cot estimate request to Water Department) <br /> Yes, Qu ntity , See attached for reference. <br /> NOT R QUIRED / <br /> lumbing Permits (Note:Permit Technicians to add all items selected bell' to Plumbing Permit-for items inside building only) <br /> Backflow revention (Inside Building): 0 DCVA (for Domestic service) 0 '/'•BA (for Domestic service) 0 DCDA (for Fire service) <br /> yt., <br /> NOT RE UIRED <br /> i <br /> Building Permits (Note:Permit Technicians to add all . s selected b low to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIG TION FEES: <br /> NILLYES, ,See Attached for calculations/credit ❑YES,Traffic itigation Total: $ <br /> To be added on PW To be a ded on C ZOO1 ' O 1q 0 See A ched for calculations/credit <br /> Quantity charged SF Quantit charged S 'NOT R UIRED <br /> $QTY is 0 Ground only 0 all hard surfaces $QTY is Roof only 0 all hard surfa s <br /> 3 <br /> ❑ NOT REQUIRED !! $$ <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned ad ss), print t Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: ❑ SFR ❑ DUPLEX ❑ADU ❑ INFILL D NG ❑ 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 /> ❑ Di ital copy attached to permit record, Permit# <br /> ❑ aved to Address Folder in Development Tech File <br /> ^I NOT R UIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Ty e <br /> NOT REUIRED <br /> eason: <br /> PUBLIC WOR S PERMIT REQUIRED? <br /> ❑YES, Permi #PW <br /> ❑ S rmwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> 31.NOT RE IRED <br /> Worksheet Completed By. / [ 'y Date. -71(I o 2-/ <br /> r <br /> Worksheet Checked By: ( P u ',cc Date: i/I /t Z1 <br /> REVISED 11/27/2019 <br />