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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3614 SHORE AVE Permit#: B2207-002 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW SFR-3,299 SF W/(3)CAR,674 SF GARAGE, PORCH,&PATIO <br /> PW Reviewer to select all that apply below: M e"r E n- E. $S-c4. 4.Jl6 KtzTc' 4 F alp. <br /> Utility Permits (Note:Permit Technicians to Create Utility Pe r Sewer, Water, Fire, and Irrigation, as selected below <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calcul. ..n&Cost Est.) <br /> ❑ New Connection to main plus connections to building ❑ New Connection, Size -❑ Pe 'ost Estimate <br /> /0 Alteration E Meter Only, Size 1" -❑ P= ost Estimate <br /> —❑ Repair E Water System Developme ee Total: $2889.00 <br /> ❑ Cap-off, quantity E Sewer System Devel. ent Fee Total:$3738.00 <br /> • Reconnection to stub E Water Service - (behind meter), Size 1" <br /> ❑ Backwater Valve ❑ Backflow ' -vention (Outside Building): ERPBA ❑ DCV: <br /> ❑ NOT REQUIRED ❑ NOT r QUIRED Vbt'� -� <br /> Explanation/Utility Permit# 21t �� Exp ation/Utility Permit# z24t3i A r43 <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) IRE SERVI E: (Attach Cost Estimate/Request for Ref•rence) <br /> ❑ New Connection, Size • ew •nnection, Size -❑ Per Cost Estimate <br /> ❑ Meter O , Size ❑ 3/" ►etect Meter Only, Service Size <br /> ❑ Water stem Development Fee Total:$ ❑ :.ckflow Prevention (Outside Building): ❑DCDA <br /> El Bac ow Prevention(Outside Building): ❑DCVA OT REQUIRED <br /> N REQUIRED Explanation/Utility Permit# <br /> planation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> E NOT REQUIRED <br /> Plumbin ermits(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) ❑RPB (for Domestic service) EDCDA(for Fire service) <br /> E N REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items sel- -d belo to associated Building Permit) <br /> STORMWATER SYSTE DEVELOPMENT S: TRAFFIC MITIGATION FEES: <br /> E YES, E See Atta ed for calculation /credit ®YES,Traffic Mitigation Total:$3994.00 <br /> To be added o 'W2207-003 To be added on B2207-002 ❑See Attached for calculations/credit <br /> Quantity ch. ged 1302SF Quantity charged 2770SF ❑ NOT REQUIRED <br /> QTY is /_ Ground only❑ all surfac s QTY is E Roof only El all surfaces Q C5p <br /> $348..: 741.81 D <br /> ❑ NO - 'EQUIRED <br /> Ad.itional Che lists: <br /> ADDRESS LETT REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> E YES—TYP- . E SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> See tached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> E I•ital copy attached to permit record, Permit#B2207-002 <br /> G� aved to Address Folder in Development Tech File <br /> ❑ OT REQUIR <br /> FIRE SPRI ERS REQUIRED? <br /> ❑ YES ype <br /> NO REQUIRED <br /> Rea on: <br /> PUBLIC WO S PERMIT REQUIRED? <br /> • YES, P mit#PW2207-003 <br /> E ormwater NPDES Tab Completed in TRAKiT E ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ N REQUIRED <br /> Worksheet Completed By: Date: 6 U Z/2v Z�—__ <br /> Worksheet Completed By: Date: <br /> `ice <br /> REVISED 12/22/2021 <br />