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im E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 2520 MADISON ST Permit#: B2208-087 <br /> TENANT: SUNRISE VIEW RETIREMENT VILLA&REHAB CENTER <br /> DESCRIPTION OF WORK: DISH INSTALL NEXT TO EXISTING WCF <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 -El 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 /> NOT REQUIRED 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 " 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, PWReviewerto send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> ga 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 /> gilding Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> V-YES, IA See Attached for calculations/credit ❑YES,Traffic Mitigation Total: $ <br /> To be added on PW To be added on 15.12-0$•o%1 ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 36' SF Z NOT REQUIRED <br /> QTY is❑ Ground only❑ all surfaces QTY is❑ Roof only® all surfaces <br /> $ __ <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 /> 4❑ Saved to Address Folder in Development Tech File <br /> NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> YES-Type <br /> NOT REQUIRED <br /> Re son: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑ YES, Permit#PW <br /> El Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT El Inspections Added in TRAKiT <br /> -NOT REQUIRED <br /> Worksheet Completed By Date: 6/ S J ZsZ2 <br /> Worksheet Completed By: Date: <br /> REVISED 12/22/2021 <br />