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EL. EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1627 PUGET DR UNIT B Permit#: B2302-011 <br /> DESCRIPTION OF WORK: Remodel of basement to ADU <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 ❑ New Connection,Size - ❑Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only,Size -❑ Per Cost Estimate <br /> ❑ Repair ❑ Water System Development Fee Total:$ <br /> El Cap-off,quantity ❑ Sewer System Development Fee Total:$ <br /> 0 Reconnec on to stub El Water S vice Line(behind meter),Size <br /> ❑ Backw er Valve ❑ Backf w Prevention(Outside Building):El RPBA ❑DCVA <br /> ® NOT QUIRED ® NO REQUIRED <br /> Exp nation/Utility Permit# Explanation/Utility Permit# <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size El New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only,Size ❑ %"Dete Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ El Backfl Prevention(Outside Building):❑ DCDA <br /> El Backfl Prevention(Outside Building):❑DCVA El NO EQUIRED <br /> El NOT EQUIRED E planation/Utility Permit# <br /> Ex anation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes,PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes,Q ntity .See attached for reference. <br /> ® NOT EQUIRED <br /> Plumbing Pe its(Note:Permit Technicians to add all items selected below to Plumbing Permit for items inside building only) <br /> Backflow evention(Inside Building): ❑DCVA(for Domestic service) El RPBA(for Domestic service) El DCDA(for Fire service) <br /> ® NOT EQUIRED <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,❑See Attached for calculations/credit ❑YES,Traffi itigation Total:$ <br /> To be added on PW To be added on El S Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF ® NOT QUIRED <br /> QTY is El Gro d only❑all surfaces QTY is❑Roof only El all surfaces <br /> $ $ <br /> ® NOT R RED _ <br /> Additiona Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address),print out Address Letter from TRAKiT Print Menu an include) <br /> ® YES—TYPE:❑SFR ❑DUPLEX ®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# B2302-011 <br /> ®Saved to Address Folder in Development Tech File <br /> NOT REQUIRED <br /> F E SPRINKLERS REQUIRED? <br /> ❑ ES—Type <br /> ® NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> El YES,Permit#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> ® NOT REQUIRED <br /> Worksheet Completed By: 744Apteyetqenm4#2 Date: 06/O17/2023 <br /> Worksheet Reviewed By:,46/41 7deetave,tr, Date: 06/08/2023 <br />