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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4929 SOUND AVE Permit#: B2207-056 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW SFR 2 STORY RES BLDG W/ATTACH ED 2 CAR 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 /> New Connection to main plus 1 connections to building ❑ New Connection, ize -❑ Per Cost Estimate <br /> ❑ Alteration Meter Only, Size SI�1i -❑ Per Cost Estimate <br /> ❑ Repair Water System Development Fee Total:$ W 3��•0� <br /> ❑ Cap-off, quantity ® Sewer System Development Fee Total:$ rJS O <br /> ❑ Reconnection to stub ❑ Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building): ❑RPBA ❑ DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED ,, 11 t _ � <br /> Explanation/Utility Permit# Explanation/UtilityPermit# V ZZ <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 /> SNOT 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 /> 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 /> Ti 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: CO <br /> El YES, El See Attached for calculations/credit VI YES,Traffic Mitigation Total: $ M-11, <br /> To be added on PW 17-0-1-0l(o To be added on B2W1' 066, ❑See Attached for calculations/credit <br /> Quantity charged: I'Leb Quantity charged I?2A SF ❑NOT REQUIRED <br /> QTY is Ground only❑ all surfaces QTY is�] Roof only El all surfaces <br /> $ 3+1.12 Al 363.5) <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 /> 2 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# g 2201-0 1 <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> Ig YES, Permit#PW 11-101^6(fp <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED l' v1�e�� I/11102)) <br /> Worksheet Completed By: �IA1k r• bI — Date: O1, <br /> Worksheet Completed By: Date: ai(z2 /io22 <br /> REVISED 12/22/2021 <br />