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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> Nom WASHINGTON <br /> PROJECT ADDRESS: 1605 EDGEMOOR LN Permit#:B2304-014 <br /> DESCRIPTION OF WORK: NEW UNCOVERED DECK,BACK NORTH SIDE OF HOUSE <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 /> El Recon ction to stub ❑ Water Service Line(behind meter),Size <br /> ❑ Ba ater Valve ❑ B flow Prevention(Outside Building): ❑RPBA ❑DCVA <br /> ® T 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 ❑ %"Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ ❑ B. kflow Prevention(Outside Building):❑DCDA <br /> ❑ Bac low Prevention(Outside Building):❑DCVA /1 1OT REQUIRED <br /> ® T 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, uantity See attached for reference. <br /> ® N REQUIRED <br /> Plumbing rmits(Note:Permit Technicians to add all items selected below to Plumbing Permit for items inside building only) <br /> Backflo revention(Inside Building): ❑DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> ® N REQUIRED <br /> Building Permits(Note:Permit Technicians to add all items selected below to as ciated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ❑ YES,❑See Attached for calculations/cre ❑YES,Traf is Mitigation Total:$ <br /> To be added on PW To be added on ee Attached for calculations/credit <br /> Quantity charged SF Quantity char d SF ® REQUIRED <br /> QTY is❑Ground only❑all surfaces QTY is❑ of only❑all surfaces <br /> $ <br /> ® N 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 Att hed Letter,2 copies(Permit Techs to issue one copy to applicant with permits,scan one copy to Jeffrey Marks) <br /> ❑Digi copy attached to permit record,Permit# <br /> ❑S ed to Address Folder in Development Tech File <br /> E N REQUIRED <br /> FIRE SPRINKLERS RE UIRED? <br /> ❑ YES— pe <br /> ® N REQUIRED <br /> eason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑ YES,Permit#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT El ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> ® NOT REQUIRED <br /> Worksheet Completed By: /44.44.14. qeftmeot Date: 05101112023 <br /> Worksheet Reviewed By:Saiethla 9041d\I. Date: 05/0912023 <br />