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0 410 <br /> ismE VE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> MINI WASHINGTON <br /> PROJECT ADDRESS: 7822 BEVERLY LN #B Permit#: B2010-017 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: BUILD DECK&ADDITION TO BUILDING <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 Syste Development Fee Total: $ <br /> ❑ Cap-off, antity 0 Sewer Sy m Development Fee Total:$ <br /> ❑ Reconn ction to stub 0 Water rvice Line (behind meter), Size <br /> CI ter Valve 0 Backf w Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> OT EQUIRED O REQUIRED <br /> xpla ation/Utility Permit#: xpl nation/Utility Permit#: <br /> IRRIGATION •ERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Con ection, Size -0 Per Cost Estimate <br /> ❑ Meter 0 Size 0 3/4"bete Meter Only, Service Size <br /> ❑Water stem Development Fee Total: $ 0 Backf Prevention (Outside Building): 0 DCDA <br /> ❑ Backfl' Prevention (Outside Building): 0 DCVA liti NO EQUIRED <br /> fxNOT EQUI' D Exp nation/Utility Permit#: <br /> pla .tion/U ity Permit#: <br /> WATER D 'ARTMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑,Yes, Q ntity , See attached for reference. <br /> NOT ' QUI' D <br /> Plum•in• '-ermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflo Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> IFLNOT QUIRED <br /> i <br /> Building Permits (Note:Permit Tech ' ians to add all items selected below to : sociated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMEN FEES: TRAFFIC MITIGATION FEES: <br /> YES, See Attached for calculations/ redit I YES,Traffic Mitigation Total: $ <br /> To be added on PW To be added on E 20( - (7 0 See Attached for calculations/credit <br /> Quantity charged S Quantity charged fi3 SF i4 NOT REQUIRED <br /> QTY is 0 Ground only 0 all hard surfa es QTY is"Fiil Roof only al hard surfaces <br /> $ $ 3- <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTE- -EQUIRED? (If yes (new assigned address), print out Address ter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: o SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MUL I-FAMILY 0 COMMERCIAL <br /> ❑See-•ttached 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 /> IIOTR••UIRED <br /> FIRE SPRI LERS REQUIRED? <br /> ❑YES— pe <br /> NOT EQUIRED <br /> eas . <br /> PUBLIC WO S PERMIT REQUIRED? <br /> ❑YES, Per it#PW <br /> ❑ tormwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> NOT R QUIRED Worksheet Completed B : Date: 1 O[O<J14 -1 <br /> Worksheet Checked By: Date: /4 /Os`/go-4-4 <br /> REVISED 11/27/2019 <br />