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im EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 1601 RUCKER AVE Permit#: B2101-030 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: FIRE DAMAGED SFR/REPAIRING ROOF FRAMING AND SHEATHING AND <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 /> 0 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 Syste evelopment Fee Total: $ <br /> ❑ Cap-off,quantity 0 Sewer Sys m Development Fee Total: $ <br /> ❑ Reconne 'on to stub 0 Water S ice Line(behind meter), Size <br /> ❑ ackw r Valve Back Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> NOT QUIRED N REQUIRED <br /> E plan tion/Utility Permit#: Expl nation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connecti n, Size 0 New Co ection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, ize 0%"D ct Meter Only, Service Size <br /> ❑Water Sys m Development Fee Total: $ ❑ Bac ow Prevention (Outside Building): 0 DCDA <br /> ❑ gackflo revention (Outside Building): 0 DCVA REQUIRED <br /> ►% NOT QUIRED xp nation/Utility Permit#: <br /> Ex•lan ion/Utili y Permit#: <br /> WATER DEP TMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Qua ity , See attached for reference. <br /> KNOT R UIRE <br /> Plumb ng rmits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Backflow P evention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> NOT RE IRED <br /> Building Permits (Note:Permit Technicians to add all items selected below • .ssociated Buildi . Permit) <br /> ST•RMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC ITIGATION FEES: <br /> ►AYES, See Attached for calculations/credit 0 YES, raffic Mitigation Total: $ <br /> To be added on PW To be added on 0.108 - G 30 ❑ .ee Attached for calculations/credit <br /> Quantity charged SF Quantity charged 8 8 16 SF I'N ri REQUIRED <br /> QTY is 0 Ground only 0 all hard surfaces QTY is la Roof only 0 all hard surfaces <br /> $ <br /> CI NOT REQUIRED $ 241S 1,4 <br /> Additional Checklists: <br /> A ESS LETTER REQUIRED? (If yes (new assigned address), print out Address Let -r from TRAKiT Print Menu and include) <br /> ❑YES—TYP : 0 SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ S e Attached Letter,2 copies (Permit Techs to issue one copy to applicant ith permits, scan one copy to Jeffrey Marks) <br /> ❑ igital copy attached to permit record, Permit# <br /> ❑ aved to Address Folder in Development Tech File <br /> )(NOT R UIRED <br /> FIRE SPRI KLERS REQUIRED? <br /> EVES—T e <br /> NOT R QUIRED , <br /> eason: <br /> PUBLIC WORK PERMIT REQUIRED? <br /> ❑YES, Permit PW <br /> ❑St rmwater NPDES Tab Completed in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> 110;\NOT RE RED Worksheet Completed By: f i`,(�`� Date: aJiti B 2 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />