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EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 9502 18TH AVE W UNIT 0 Permit#: B2310-024 <br /> DESCRIPTION OF WORK: NEW SFR-REF RB2306-005--UNIT 0 <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Uti' it for Sewer, ter,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,Size - ❑ Per Cost Estimate <br /> ❑ Alteration ® Meter Only,Size 3/4-inch-❑ Per Cost Estimate <br /> ❑ Repair ® Water System Development Fee Total:$4,311.00 <br /> ❑ Cap-off,quantity ® Sewer System Development Fee Total:$5,580.00 <br /> n Reconnection to stub El Water Service Line(behind meter),Size <br /> Backwater Valve El Backflow Prevention(Outside Building):0 RPBA 0 DCVA <br /> 0 NOT REQUIRED ❑ NOT REQUIRED <br /> Explanation/Utility Permit# Ex lanation/Utility Permit# <br /> IRRIGATION SERVI E:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> El New Conne ion,Size El New Connecti.n,Size -❑Per Cost Estimate <br /> El Meter 0 y,Size ❑ %"Detect eter Only,Service Size <br /> El Wate ystem Development Fee Total:$ ❑ Backfl., Prevention(Outside Building):0 DCDA <br /> ❑Oa flow Prevention(Outside Building):❑DCVA ® NO 'EQUIRED <br /> ® T REQUIRED E slanation/Utility Permit# <br /> Explanation/Utility Permit# <br /> WATER DEP TMENT COST ESTIMATE NEEDED-(If yes,PW Reviewer to send cost estimate request to Water Department) <br /> El Yes,Q ntity ,See attached for reference. 1 1k2 �71 <br /> ElV NOT EQUIRED , k0 0*. 0 S ✓ <br /> Plumbing Permi (Note:Permit Technicians to add all items selected below to Plumbing Permit for items inside building only) <br /> Backflow Prev tion(Inside Building): El DCVA(for Domestic service) El RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> ® NOT RE IRED <br /> Building Permits(Note:Permit Technicians to add all items selected below to associated Building P rmit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ❑ YES,❑See Attached for calculations/credit ®YES,Traffic Mitigation Total:$4,993.0 <br /> To be added on PW To be added on ❑See Attached for calculations/c edit <br /> Quantity charged SF Quantity charged SF El NOT REQUIRED <br /> $TY is El Ground only❑all surfaces $TY is El Roof only El all surfaces <br /> O D�� <br /> 2 <br /> ® NOT R UIRED C.-0N c=-f—o c.,.� -P'w 2Z 1I- 0 2.1 <br /> Addi onal Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address),print out Address Letter from KIT 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#B2310-024 <br /> ®Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> O YES—Type <br /> ® NOT REQUIRED , <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> El YES,Permit#PW <br /> El Stormwater NPDES Tab Completed in TRAKiT El ADA Tab Completed in TRAKiT El Inspections Added in TRAKiT <br /> ® NOT REQUIRED <br /> Worksheet Completed By: Wad 7leefoote Date:1O/TO/2023 <br /> Worksheet Reviewed By: c I LO I 1_,fJ23 <br />