1223 LOMBARD AVE 2025-01-24 - Laserfiche WebLink

EVERETT PUBLIC WORKS REVIEW WORKSHEET WASHINGTON PROJECT ADDRESS: 1223 LOMBARD AVE Permit#: C1904-001 TENANT: [TenName] DESCRIPTION OF WORK: CONSTRUCT NEW DADU WITH 2 CAR GARAGE BELOW PW Reviewer to select all that apply below: Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) ❑ New Connection to main plus connections to building ❑ New Connection, Size - 0 Per Cost Estimate EtAlteration—ift,50 0 Meter Only, Size -❑ Per Cost Estimate ❑ Repair 0 Water System Development Fee Total $ ❑ Cap-off, quantity 0 Sewer System Development Fee Total: $_ ❑ Reconnection to stub tit Water Service Line (behind meter), Size_ 3 0'1 G rut a Backwater Valve El Backflow Prevention (Outside Building): ❑ R BA orW ❑ DCVA/ 51 NOT REQUIRED p'NOT REQUIRED _ Explanation/Utility Permit#: Explanation/Utility Permit#: VIVO/ IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) ❑ New Connection, Size 0 New Connection, Size - 0 Per Cost Estimate ❑ Meter Only, Size ❑3/4" Detect Meter Only, Service Size ❑ Water System Development Fee Total: $ Backflow Prevention (Outside Building): 0 DCDA ❑ Backflow Prevention (Outside Building): 0 DCVA DA NOT REQUIRED &NOT REQUIRED Explanation/Utility Permit#: Explanation/Utility Permit#- WATER DEPARTMENT COST ESTIMATE NEEDED-(lf yes, PW Reviewer to send cost estimate request to Water Department) ❑Yes, Quantity , See attached for reference. NOT REQUIRED Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) Backflow Prevention (Inside Building): 0 DCVA (for Domestic service) 0 RPBA (for Domestic service) 0 DCDA (for Fire service) 'NOT REQUIRED Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: YES, Stormwater Total: $_ -32,7-1 _ ❑YES, Traffic Mitigation Total: $ 0 Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 See Attached for calculations/credit El All Hard Surface Fees to be added to Permit# C j yr O S`—<CV ) 17.NOT REQUIRED pir See Attached Spreadsheet for calculations/credit // ❑ nroT REQUIRED Additional Checklists: ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) ❑YES—TYPE: 0 SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL ❑ See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) ❑ Digital copy attached to permit record, Permit# ❑ Saved to Address Folder in Development Tech File 61(4OT REQUIRED FIRE SPRINKLERS REQUIRED? ❑YES—Type NOT REQUIRED Reason- PUBLIC WORKS PERMIT REQUIRED? ❑YES, Permit#PW ❑ Stormwater NPDES Ta ompleted in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT KNOT REQUIRED 7 Worksheet Completed By: '�- Date: Worksheet Checked By: Date: 5 b///I 2019 REVISED 4/24/2019