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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1815 HOLBROOK AVE Permit#: B2211-002 <br /> DESCRIPTION OF WORK: NEW SFR ON VACANT 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 1 connections to building ® New Connection, Size 3/4"-El Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ® Water System Development Fee Total:$4311.00 <br /> ❑ Cap-off,quantity ® Sewer System Development Fee Total:$5580.00 <br /> ❑ Reconnection to stub ❑ Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ Backflow Prevention (Outside Building): ❑RPBA ❑ DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED <br /> Explanation/Utility Permit#U 23o 1—0 Explanation/Utility Permit# C_,Z 330 7-615 <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size El New Connection, Size -El Per Cost Estimate <br /> ❑ Meter Only, Size ❑ ' " Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): ❑DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑DCVA ® NOT REQUIRED <br /> ® NOT REQUIRED Explanation/Utility Permit# <br /> Explanation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PWReviewerto send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> ® 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): ❑DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> • 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 /> ® YES, El See Attached for calculations/credit ®YES,Traffic Mitigation Total: $4993.00 <br /> To be added on PW2211-001 To be added on ❑See Attached for calculations/credit <br /> Quantity charged 4,937SF Quantity charged SF ❑ NOT REQUIRED <br /> QTY is El Ground only® all surfaces QTY is❑ Roof only El all surfaces <br /> $1,330.63 $ <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 /> El YES—TYPE: ® SFR El DUPLEX El ADU El INFILL DWELLING ❑ MULTI-FAMILY El 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#B2211-002 <br /> ® Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> ® NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ® YES, Permit#PW2211-001 <br /> • Stormwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRAKiT ® Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: _.. / Date: 3 Z c _3 <br /> Worksheet Completed By: Date: <br /> REVISED 10/07/2022 <br />