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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3003 W CASINO RD Permit#: PW2012-028 <br /> TENANT: BOEING#45-06 <br /> DESCRIPTION OF WORK: Sitework For Boeing Campus <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 - ❑ Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off,quantity 0 Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> El Backwater Valve p,Backflow Prevention (Outside Building): ❑ RPBA or 0 DCVA <br /> „b NOT REQUIRED C] 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 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0%" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> D,,Backflow Prevention (Outside Building): ❑ DCVA OCNOT REQUIRED <br /> 0,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 /> D,Yes, Quantity , See attached for reference. <br /> £I 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): 0 DCVA (for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> O'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 /> t1 YES, I3.See Attached for calculations/credit ❑YES,Traffic Mitigation Total: $ <br /> To be added on PW Z0\2- - 0 2 To be added on ❑ See Attached for calculations/credit <br /> Quantity charged Sb SF Quantity charged SF 141 NOT REQUIRED <br /> QTY is J.Ground only 0 all hard surfaces QTY is 0 Roof only❑ all hard surfaces �� <br /> $ 13261.`t0 $ <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 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 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 /> / 0 Saved to Address Folder in Development Tech File <br /> (1,,NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> ) NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> DLYES, Pen-nit#PW 20l - -0 Z-' <br /> E3,Stormwater NPDES Tab Completed in TRAKiT f3ADA Tab Completed in TRAKiT 1"inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> , <br /> Worksheet Completed By: P; „ Date: 2-!'2 j'L <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />