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E V E R E T T <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 2115 15TH ST Permit #: PW2205-013 <br />TENANT: [TenName] <br />DESCRIPTION OF WORK: REMOVE OLD CONCRETE STEPS&SECTION OF WALKWAY, REPLACE W/ NEW <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 />❑ 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 ❑ '/" 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, 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 />® NOT REQUIRED <br />Building Permits (Note: Permit Technicians to add all items selected below to associated <br />Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />TRAFFIC MITIGATION FEES: <br />® YES, ® See Attached for calculations / credit <br />❑ YES, Traffic Mitigation Total: $ <br />To be added on PW2205-013 To be added on <br />❑See Attached for calculations/credit <br />Quantity charged 52SF Quantity charged SF <br />® NOT REQUIRED <br />QTY is ® Ground only ❑ all surfaces QTY is ❑ Roof only ❑ all surfaces <br />$13.93 <br />❑ NOT REQUIRED <br />Additional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br />RYES -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 />❑ 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 />® YES, Permit # PW2205-013 <br />® Stormwater NPDES Tab Completed in TRAKiT ® ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: Date: 06/04/2022 <br />Worksheet Completed By: Date: <br />REVISED 12122/2021 <br />