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"Lim E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> mimi WASHINGTON <br /> PROJECT ADDRESS: 2905 MAPLE ST Permit#: B2202-042 <br /> TENANT: M A MORTENSON 2ND CONF RM <br /> DESCRIPTION OF WORK: 2ND CONF RM MOBILE OFFICE,24X64 WITH 2 RESTROOMS HOOKED TO <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 /> ❑ Cap-off,quantity ❑ Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub ❑ Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ Backflow Prevention (Outside Building): ❑RPBA ❑ DCVA <br /> at-NOT REQUIRED I -NOT 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 ❑ New Connection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size ❑ 3/4"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-(If yes, PW Reviewer to 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 /> R'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 /> E —YES, RI See Attached for calculations/credit ❑YES,Traffic Mitigation Total:$ <br /> To be added on PW To be added on$2?242•b 4Z ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 153%,SF il..N1OT REQUIRED <br /> QTY is❑ Ground only❑ all surfaces QTY is IhRoof only❑ all surfaces <br /> $ 1411.3+ <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: ❑ 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# <br /> ❑ Saved to Address Folder in Development Tech File <br /> ]-NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> Fr OT REQUIRED <br /> eason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> [ACES, Permit#PW22o2.-oil <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: 1(j 2 I1--01'z <br /> Worksheet Completed By: Date: <br /> REVISED 12/22/2021 <br />