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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 7711 BEVERLY BLVD #B Permit#: B2104-073 <br /> TENANT: KIDI AFH <br /> DESCRIPTION OF WORK: ADULT FAMILY HOME-CONVERT LOWER LEVEL OF SFR/CONVERT GARAGE <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 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 /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> KNOT REQUIRED KNOT 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 3/4' Detect Meter Only, Service Size <br /> 0 Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA JgNOT REQUIRED <br /> NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-Ofyes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference <br /> KNOT 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 /> KNOT 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 /> 14 YES, 0 See Attached for calculations/credit 0 YES,Traffic Mitigation Total: $ <br /> To be added on PW2203-005 To be added on 0 See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF 10 NOT REQUIRED <br /> QTY is Pit Ground only 0 all hard surfaces QTY is❑ Roof only 0 all hard surfaces <br /> $ 5;15 $ <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: 0 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 /> ❑ Saved to Address Folder in Development Tech File <br /> St NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> IS(NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> KYES, Permit#PW aZ Q3'Oo <br /> Stormwater NPDES Tab Completed in TRAKiT El/ADA Tab Completed in TRAKiT ®'Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: g1q /2Q ?.. <br /> Worksheet Checked By. Date: <br /> REVISED 11/27/2019 <br />