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E V E R E T T <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECTADDRESS: 1626 BAKER AVE Permit#: B2303-043 <br />DESCRIPTION OF WORK: ADDITION OF 297 SQ FT LIVING SPACE ON NE SIDE OF STRUCTURE <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 ❑ <br />New Connection, Size _- ❑ Per Cost Estimate <br />❑Alteration <br />❑ Meter Only, Size _-❑ Per Cost Estimate <br />❑ Repair ❑ Water System <br />Development Fee Total: $_ <br />❑ Cap -off, quantity ❑ Sewer System Development <br />Fee Total: $_ <br />❑ Reconnection to stub ❑ Water Service Line (behind meter), Size <br />_ <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 _ ❑ X" Detect Meter Only, Service Size <br />_ <br />❑ Water System Development Fee Total: $ ❑ Back -flow Prevention (Outside Building): ❑ DCDA <br />❑ Backflow Prevention (Outside Building): ❑ DNA NOT REQUIRED <br />® NOT REQUIRED Explanation/Utility Permit#_ <br />Expla nation/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 />® NOT REQUIRED <br />Building Permits (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />TRAFFIC MITIGATION FEES: <br />® YES, ® See Attached for calculations / credit <br />❑ YES, Traffic Mitigation Total: $_ <br />To be added on PW 230s a S To be added on B2303-043 <br />❑ See Attached for calculations/credit <br />Quantity charged bAaSF Quantity charged 323SF <br />® NOT REQUIRED <br />QTY is ® Ground only ❑ all surfaces QTY is ® Roof only ❑ all surfaces <br />$ N14.tat $85.96 <br />❑ NOT REQUIRED <br />Additional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKi f Print Menu and include) <br />❑ YES -TYPE: ❑ SFR [-]DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY [-]COMMERCIAL <br />❑ See Attached Letter, 2 copies (PermitTechs 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 #PW 2J01r-A Ijr <br />Y(Stormwater NPDES Tab Completed in TRAKiT [XADA Tab Completed in TRAK7 ❑ Inspections Added in TRAK7 <br />NOT REQUIRED <br />7/nA- <br />Worksheet Completed By: cI44/Date: 04101/2029 <br />Worksheet Reviewed By: �Aiy lseoyl`Date: 0S"--2 4/ - 2a Z•3 <br />