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EVE R E TT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3314 ROCKEFELLER AVE Permit#: B2005-036 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONVERT EXTG GARAGE INTO A DWELLING UNIT <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 /> 0 New Connection to main plus connec. ns to building 0 New Connection, Size -0 Per Cost Estimate <br /> Alteration ❑ Meter Only, Size -0 Per Cost Estimate <br /> Repair ❑ Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity 0 Sewer ystem Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Wate Service Line (behind meter), Size <br /> Backwater Valve 0 Ba flow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED ` � Q1 N T REQUIRED <br /> Explanation/Utility \J��-� O( 'O <br /> Permit#: \ !� Ex anation/Utility Permit#: <br /> IRRIGATIO SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Co nection, Size 0 New Con ection, Size - 0 Per Cost Estimate <br /> ❑ Meter nly, Size 0%" De ct Meter Only, Service Size <br /> ❑Wat System Development Fee Total: $ ❑ Bac ow Prevention (Outside Building): 0 DCDA <br /> ❑ Ba flow Prevention (Outside Building): 0 DCVA tRI-NO REQUIRED <br /> 5f•N T REQUIRED Exp nation/Utility Permit#: <br /> Exp anation/Utility Permit#: <br /> WATER PARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, uantity , See attached for reference. <br /> SNOT EQUIRED <br /> Plumbin ermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Backflo Prevention (Inside Building): ❑ DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA (for Fire service) <br /> NOT QUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER S TEM DEVELOPMENT FEES: TRAFFIC IGATION FEES: <br /> ❑YES, Stormw er Total: $ 0 YES,T affic Mitigation Total: $ <br /> ❑ Roof O y Fee on Bldg Permit(ground hard surfaces fee on PW Permit) 0 e Attached for calculations/credit <br /> ❑All H d Surface Fees to be added to Permit# "'NO REQUIRED <br /> ❑ Se Attached Spreadsheet for calculations/credit <br /> RIOT QUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print t Address Letter from TRAKiT Print Menu and include) <br /> 144YES-TYPE: ❑ SFR ❑ DUPLEX gADU 0 INFILL DWELL G 0 MULTI-FAMILY ❑ COMMERCIAL <br /> tirSee Attached Letter, 2 copies (Permit Techs to issue one opy to applicant with permits, scan one copy to Jeffrey Marks) <br /> RDigital copy attached to permit record, Permit# " 0.3 CP <br /> I»Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUI D <br /> FIRE SPRIN LERS REQUIRED? <br /> ❑YES-Ty e <br /> GI NOT R QUIRED / <br /> Reason: <br /> i <br /> PUBLI WORKS F RMIT REQUIRED? <br /> ❑YES, Permit#,IW <br /> 0 Stor water NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> Lf'NOT REQ ED <br /> �J / -, <br /> Worksheet ompleted By f- `_- l Date: 11 l245-1 Zd to <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />