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EVERETT �* - <br />PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 1903 JACKSON AVE UNITS A & B Permit #: B2311-025 <br />DESCRIPTION OF WORK: NEW DUPLEX AFTER DEMO OF EXISTING_ SFR <br />PW Reviewer to select all that apply below: <br />tility Permits (Note: Perms chnicians 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 3�N' - ❑Per Cost Estimate <br />❑ Alteration ❑ Meter Only, Size - ❑ Per Cost Estimate <br />❑ Repair ® Water System Development Fee Total: $ H 511. <br />❑ Cap -off, quantity Sewer System Development Fee Total: $ L4018,°� . <br />® Reconnection to stub ® Water Service Line (behind meter), Size H <br />❑ Backwater Valve ❑ Backflow Prevention (Outside Building): ❑ RPBA ❑ DCVA <br />❑ NOT REQUIRED `(f 3 ❑ NOT REQUIRED . <br />� 'o <br />Explanation/Utility Permit # �1Explanation/UtilityPermit # -QZg0S—o <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 ❑ %" Detect Meter Only, Service Size <br />❑ Water System Development Fee Total: $ ❑ Backfl revention (Outside Building): ❑ DCDA <br />❑ Baggow Prevention (Outside Building): ❑ DCVA ® REQUIRED <br />® IT REQUIRED Explanation/Utility Permit # <br />Explanation/Utility Permit# <br />WATER DEPAPWIENT COST ESTIMATE NEEDED-(/f yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, Q tity , See attached for reference. <br />[S NO EQUIRED <br />, <br />Plumbing Per its (Note: Permit Technicians to add all items selected below to Plumbing Permit for items inside building only) <br />Backflow evention (Inside Building): ❑ DCVA(for Domestic service) ❑ RPBA(for Domestic service) ❑ DCDA (for Fire service) <br />JA NO REQUIRED <br />associat Building P rmit) <br />Building Permits (Note: Permit Technicians to add all items selecte/111 <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />TRAFFIC MITIGATION FEES: <br />® YES, ® See Attached for calculations / cre it � <br />Oti`� <br />® YES, Traffic Mitigation Total: $5592.00 <br />To be added on PW2311-023 To be added on <br />® See Attached for calculations/credit <br />Quantity charged IIZ3 SF Quantity charge <br />❑ NOT REQUIREDAV41e i= ll� I eN•QTY <br />is Ground only ❑all surfaces QTY is ®Roof surfaces <br />�I`b�1.33 <br />�.1�' 2� C1'�' ' F$�iZ <br />$N- N �j35 55 s <br />❑ NOT REQUIRED <br />Additional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (new signed address), print out Address Letter fr m TRAKiT 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 PWClerical@everettwo.gov) <br />® Digital copy attached to permit record, Permit # B2311-025 <br />® Saved to Address Folder in Development Tech File <br />❑ NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES Type <br />JA NOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />® YES, Permit # PW2311-023 <br />® Stormwater NPDES Tab Completed in TRAKiT ® ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: lCil a%!j' ri"PJLm" Date: <br />Worksheet Reviewed B — Date: o 4-1Sr'1Z'Z4 <br />