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EVE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4400 CRESCENT AVE Permit#: B2403-141 <br /> DESCRIPTION OF WORK: NEW 3 BEDROOM SFR(RB2307-001) <br /> PW Reviewer to select all that apply below: <br /> tility Permits (Note:Permit Technicians to Create Utility Pe 't for Sewer, er,Fire,and Irrigation,as selected below) <br /> ANITARY SEWER: DOMESTIC WATER SERVICE:(Attach Calculation&Cost Est.) <br /> ® New Connection to main plus 1 connections to building❑ Alteration <br /> ❑ Repair <br /> ❑ New Connection,Size El Per Cost Estimate <br /> ® Meter Only,Size 1-inch Dom/Fire Combo-ElPer Cost Estimate <br /> El Water System Development Fee Total:$4,577.00 <br /> ❑ Cap off,quantity ® Sewer System Development Fee Total:$4,028.00 <br /> 1❑ Reconnection to stub / El Water Service Line(behind meter),Size <br /> ❑ Backwater Valve / ❑ Backflow Prevention(Outside Building):❑RPBA ❑DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit# U2ACS 1''A( Explanation/Utility Permit# el.2`'''rr�03 -14( <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size ❑ New Connection,Size -❑ Per Cost Estimate <br /> 0 Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building):❑ DCDA <br /> ❑ Back w Prevention(Outside Building):❑DCVA ® NOT REQUIRED <br /> ® 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, ntity ,See attached for reference. <br /> ® REQUIRED <br /> Plumbing Per its(Note:Permit Technicians to add all items selected below to Plumbing Permit for items inside building only) <br /> Backflow P vention(Inside Building): El DCVA(for Domestic service) ❑ RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> ® N EQUIRED <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:$5,592.00 <br /> To be added on PW2405-028 To be added o 0 See Attached for calculations/credit <br /> Quantity charged 1640SF Quantity c ged OSF 0 NOT REQUIRED <br /> QTY is❑Ground only®all surfaces QTY is Roof only❑all surfaces `f <br /> ` <br /> $747.00 $ b C�1OJ r'\ A I <br /> El 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 /> ® YES—TYPE:®SFR ❑DUPLEX ❑ADU 0 INFILL DWELLING ❑ MULTI-FAMILY El COMMERCIAL <br /> ®See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits,scan one copy to PWClerical@everettwa.gov) <br /> ® Digital copy attached to permit record,Permit#B2403-141 <br /> ®Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> El YES Type <br /> ® NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ® YES,Permit#PW2405-028 <br /> ®Stormwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRAKiT ® Inspections Added in TRAKiT <br /> El NOT REQUIRED <br /> Worksheet Completed By: 74ad 7/ecootte Date:0511712024 <br /> Worksheet Reviewed By:/l1 "1:— Date: L4za Zy <br />