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im EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 2413 74TH ST SE Permit#: PW2210-001 <br /> TENANT: <br /> DESCRIPTION OF WORK: SITEWORK FOR NEW SFR WITH ATTACHED GARAGE <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 /> VI New Connection to main plus connections to building 1I New Connection, Size 314 -❑ Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 19 Water System Development Fee Total:$ 931(.0 <br /> ❑ Cap-off,quantity ft Sewer System Development Fee Total: $ 65166,00 <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or❑ DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED <br /> Explanation/Utility Permit#: v 2 3 6 4 - 6 ZZ Explanation/Utility Permit#: U 2 3 0 q-- 021. <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA TaNOT REQUIRED <br /> W NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> SNOT 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) 0 DCDA(for Fire service) <br /> KNOT 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: 0� <br /> 'YES,' I See Attached for calculations/credit DTraffic <br /> YES, Mitigation Total: $ ��� <br /> ' . <br /> To be added on PW et( To be added on 122.E Q V ❑ See Attached for calculations/credit <br /> Quantity charged 0,63 SF Quantity charged UN SF ❑ NOT REQUIRED <br /> QTY is Er Ground only 0 all hard surfaces QTY is IS Roof only❑all hard surfaces <br /> $ 356. 55 $ 5 <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 /> 14 YES—TYPE: Ill SFR ❑DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> El 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# V)1-11.0-6161 <br /> IS Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> KNOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> 'YES, Permit#PW ZZLD- 061 t nli <br /> Stormwater NPDES Tab Completed in TRAKiT IS ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: �^ Date: << 1 6 2J �zv ikLAIVIWL(1/46kh <br /> 1. <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />