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0 • <br /> - EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> Ems WASHINGTON <br /> PROJECT ADDRESS: 405 SE EVERETT MALL WAY Permit#: PW2109-016 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: ELECT VEHICLE CHARGING STATION IN THE EXTG TARGET PRKG LOT <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 ❑Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ❑Water System Development Fee Total: $ <br /> ❑ Cap-off,quantity 0 Sewer stem Development Fee Total: $ <br /> ❑ Recon ection to stub 0 Wate ervice Line(behind meter),Size <br /> ❑ Bac ater Valve 0 Ba flow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> $NO REQUIRED >13N T REQUIRED <br /> Expl ation/Utility Permit#: Explanation!Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size ❑ New Connection,Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/"Detect Meter Only, Service Size <br /> ❑Water Sy tem Development Fee Total:$ ❑ Bac ow Prevention(Outside Building): ❑ DCDA <br /> ❑ Backflo Prevention(Outside Building): 0 DCVA VO REQUIRED <br /> NOT QUIRED Expl nation/Utility Permit#: <br /> Explan ion!Utility Permit#: <br /> WATER DEP RTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qu tity , See attached for reference. <br /> ]IGNOT QUIRED <br /> Plumbing P rmits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow P vention(Inside Building): CIDCVA(for Domestic service) ElRPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> KNOT RE IRED <br /> wilding Permits (Note:Permit nicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT ES:iB <br /> TRAFFIC MITIGATION FEES: <br /> %YES, El See Attached for calculations/credi 0 YES,Traffic Mitigation Total:$ <br /> To be added on PW Z!rO I. be added on <br /> 9— 0 See Attached for calculations/credit <br /> Quantity charged 7l O / SF Q antity charged SF NOT REQUIRED <br /> QTY isfitGround only/❑all hard surfaces Q Y is❑ Roof only 0 all hard surfaces <br /> $ Z43. �� $ <br /> CI NOT REQUIRED <br /> . "onal Checklists: . <br /> ADDRESS LETTER REQUIRED? (If yes( ew assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: 0 SFR 0 DUPLEX 0 ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑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 /> ❑Saved to Address Folder in Development Tech File <br /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> igl NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ce-Stormwater NPDES Tab Completed in TRAKiT ,f-ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: 4 i Date: r, q <br /> Worksheet Checked By: Date: C 9 20/20e <br /> REVISED 11/27/2019 <br />