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EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 8417 EVERGREEN WAY STE 3 Permit#:B2309-071 <br /> DESCRIPTION OF WORK: TI-INITIAL BUILD OUT FROM VACANT RETAIL SPACE INTO MOCHINUT <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 /> ❑ Reconne on to stub ❑ Water Service Line(behind meter),Size <br /> ❑ Back ter Valve 0 Backfl Prevention(Outside Building):❑RPBA ❑DCVA <br /> ® N REQUIRED ® N REQUIRED <br /> xplanation/Utility Permit# xplanation/Utility Permit# <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size 0 New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only,Size ❑ %"Det ct Meter Only,Service Size <br /> ❑ Water Syst Development Fee Total:$ ❑ Bac ow Prevention(Outside Building):❑DCDA <br /> ❑ Backflo revention(Outside Building):0 DCVA ® T REQUIRED <br /> ® NOT QUIRED Explanation/Utility Permit# <br /> Ex anation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(lf yes,PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes,Q ity ,See attached for reference. <br /> ® NO SQUIRED <br /> Plumbing Permits(Note:Permit Technicians to add all items selected below to Plumbing Permit for items inside building only) <br /> Backflow Pr ntion(Inside Building): ❑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 ermit) � . <br /> � 223 D5 <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ❑ YES,❑See Attached for calculations/credit ®YES,Traffic Mitigation Total:$$8±7O U <br /> To be added on PW To be added on ®See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF 0 NOT REQUIRED W.r ' 1 <br /> 7‘ <br /> QTY is❑Gr nd only❑all surfaces QTY is❑Roof only 0 all surfaces ff�� r 1 1n�Tv <br /> ® NO EQUIRED $ 2,,�f 'V�1,�I 2 L I W <br /> Ad itional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address),print out Address Letter from T AKiT 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 PWClerical@everettwa.gov) <br /> ❑Digital copy attached to permit record,Permit# <br /> ❑Saved to Address Folder in Development Tech File <br /> ® NOT REQUIRED <br /> FIRE SPRINKLERS RE UIRED? <br /> S—T e n l� —. r&fei .i-D 6 cl <br /> NTEU E �'�' <br /> Re son: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑ YES,Permit#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> ® NOT REQUIRED <br /> Worksheet Completed By: to u a 'P.1Zl u t Date: 1110312023 <br /> Worksheet Reviewed By: ?k! G,f,6Lt Date: 11103/2023 <br />