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EV E R E T T <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 9530 HOLLY DR Permit M PW2203-033 <br />TENANT: <br />DESCRIPTION OF WORK: SITE WORK FOR PROPOSED SHORT SUBDIVISION Sae-11 <br />SP^' a< <br />PW Reviewer to select all that apply below: CAnA <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water Fire, and Irrigation, a selected below) <br />SANITARY SEWER: DOMESTIC WATER SERVICE: (A ch Calculation & Cost Est.) <br />❑ New Connection to main plus connections to building New Connection, Size rr - 0 Per Cost Estimate <br />❑ Alteration ❑ Meter Only, Size - 0 Per Cost Estimate <br />❑ Repair Sanitary Sewer by MWWD ❑ 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): 0 RPBA or 0 DCVA <br />BSI NOT REQUIRED ❑ NOT REQUIRED <br />Explanation/ Utility Permit M Explanation/ Utility Permit #: <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE, (Attach Cost Estimate /Requestfor Reference) <br />❑ New Connection, Size ❑ New Connection, Size - 0 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 AV NOT REQUIRED <br />)KNOT REQUIRED Explanation/ Utility Permit #: <br />Explanation/ Utility Permit #: <br />WATER DEPARTMENT COST ESTIMATE NEEDED-(Ifyes, PW Reviewer to send cost estimate request to Water Department) <br />JKYes, Quantity i 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 />YkNOT 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 />"KYESXSee Attached for calculations / credit <br />❑ YES, Traffic Mitigation Total: $ <br />To be added on PW?jo3 -03A To be added on <br />❑ See Attached for calculations / credit <br />Quantity charged ,5% y g 3 SF Quantity charged SF <br />XNOTREQUIRED <br />QTY is 0 Ground only 0 all hard surfaces QTY is 0 Roof only O all hard surfaces <br />$ 5 9* $ <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 />❑ 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 />❑ Saved to Address Folder in Development Tech File <br />ANOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />A YES -Type 1113 b <br />❑ NOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />& YES, Permit # PW 29L 3 - 0 33 <br />19I.Stormwater NPDES Tab Completed in TRAKiT WDA Tab Completed in TRAKiT T�ilOnspections Added in TRAKiT <br />❑ NOT REQUIRED <br />,/ ,y <br />Worksheet Completed By:^/mil 4 • Y / 5 Date: /O / O 7- 11 7_0 2 "1-- <br />Worksheet Checked By: Date: <br />REVISED 1112712019 <br />