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am EV E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> Nom WASHINGTON <br /> PROJECT ADDRESS: 417 TAMARACK AVE Permit#: PW2212-012 <br /> DESCRIPTION OF WORK: SITEWORK FOR DEMO OF EXISTING SFR,CONSTRUCTION OF NEW SFR <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 /> 1 ❑ 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 /> ® Reconnection to stub ® Water Service Line(behind meter),Size 3/4" <br /> \ ❑ Backwater Valve ❑ Backflow Prevention(Outside Building):❑RPBA ❑DCVA <br /> ❑ NOT REQUIRED p^� ❑ NOT REQUIRED Q+ <br /> Explanation/Utility Permit#U Z O VL— � Explanation/Utility Permit#( —O� <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> O New Connection,Size ❑ New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only, e ❑ %"Detec eter Only,Service Size <br /> ❑ Water S em Development Fee Total:$ ❑ Back w Prevention(Outside Building):❑DCDA <br /> ❑ Backf w Prevention(Outside Building):❑DCVA ® N REQUIRED <br /> ® N REQUIRED xplanation/Utility Permit# <br /> xplanation/Utility Permit# <br /> WATER DEPA ENT COST ESTIMATE NEEDED-(If yes,PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes,Q tity ,See attached for reference. <br /> ® N EQUIRED <br /> Plumbing Permit (Note:Permit Technicians to add all items selected below to Plumbing Permit for items inside building only) <br /> Backflow Pre ntion(Inside Building): ❑DCVA(for Domestic service) ❑ RPBA(for Domestic service) ❑ DCDA(for Fire service) <br /> ® NOT UIRED <br /> Building Permits(Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGA N FEES: <br /> ® YES,®See Attached for calculations/cred' ❑YES,Traffi itigation Total:$0.00 <br /> To be added on PW- To be added on B2212-046 ❑ e Attached for calculations/credit <br /> Quantity charged OSF Quantity charged OSF ® NO EQUIRED <br /> QTY i Ground only❑all aces QTY is® Roof only❑all surfaces <br /> $0.00 a5c4.3 3 $702.71 <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> / <br /> ADDRESS LETTER REQUIRED? (If yes(ne assigned address),print out Address Letter from TRAKiT Print Menu and inclu <br /> ® YES—TYPE:®SFR ❑DUPLEX ❑ADU INFILL DWELLING 0 MULTI-FAMILY ❑COMMERCIAL <br /> ®See Attached Letter,2 copies(Permit Techs 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 SPRINKLE REQUIRED? <br /> ❑ YES—Typ <br /> ® NOT R UIRED <br /> Rea n: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ® YES,Permit#PWPW2212-012 <br /> ®Stormwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRAKiT ®Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED / <br /> Worksheet Completed By: evui tes dot Date:4/4/2023 <br /> Worksheet Reviewed By: Date: LI I I 0 1Ser13 <br />