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4Fir PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/30/2017 <br /> Permit#: C1710-015 <br /> PROJECT ADDRESS: 1616 126TH ST SE <br /> DESCRIPTION OF WORK: SFR ADDITION/REMODEL <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: MYERS ANNE MARIE NAME: JM CONSULTING DESIGN <br /> ADDRESS: 1616 126TH ST SE ADDRESS: <br /> EVERETT,WA, 98208 <br /> PHONE: PHONE: 4258217518 <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: MILLER JEFF <br /> PHONE: 4258217518 <br /> EMAIL: jeff.miller@jmconsultingdesign.com <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?rt YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: Ftc1 ig0.3-0W <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ❑YES-Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ONO <br /> Explanation n �o /t-6z[f->:— (€ JVs `�Explanation i <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑YES-Amount$ 0 YES-Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0 3/4" Detect Meter Only, 0 Fire Service Size <br /> V NO ts(NO <br /> Explanation: Explanation. <br /> N Ir] RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> Nf$❑Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> ❑ YES-Amount$ ❑ New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> tit'NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES-Amount$ ❑ See Attached Spreadsheet <br /> E(NO-No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES-Amount$ ❑ See Attached Spreadsheet <br /> ErNO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑�/YES-TYPE ❑ See Attached Letter <br /> 'EI NO <br /> PW Reviewer: Date: <br /> .� - 313 lE <br /> REVISED 10/11/2016 <br />