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ii.in E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 6522 WETMORE AVE Permit#: PW2108-069 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: SITE WORK FOR 2 LOT SHORT PLAT C.omp'�ti <br /> Sep s (;Q <br /> PW Reviewer to select all that apply below: iyAo ID Mo" tr <br /> Utility Permits (Note:Permit Technicians to Create Utili Permit for Sewer, Water, Fire, and Irrigation, as elected below) <br /> ANITARY SEWER: DOMESTIC WATER SERVICE: (Att h Calculation&Cost Est.) <br /> ® New Connection to main plus 1 connections to building ® New Connection, Size 3/4" -❑ 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 <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building): ❑RPBA ❑ DCVA <br /> ❑ NOT REQUIRED ^ ❑ NOT REQUIRED n-�� _/� <br /> Explanation/Utility Permit# U2.2.'t v Explanation/Utility P- mit# L1�(4 - V2' <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVIC • (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connecti n, Size ❑ New Co -ection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, ize ❑ 3/" De ct Meter Only,Service Size <br /> ❑ Water Sy em Development Fee Total:$ ❑ Ba ow Prevention (Outside Building): ❑DCDA <br /> ❑ Backflo Prevention(Outside Building): ❑DCVA ® 4T REQUIRED <br /> ® NOT QUIRED xplanation/Utility Permit# <br /> f. Exp nation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ® Yes, Quantity 1 , See attached for reference. <br /> ❑ NOT REQUIRED <br /> lumbin Permits(N. e:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building ly) <br /> Bac w revention (Insid= :uilding): ❑DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for 'e service) <br /> ® NO REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Perm' <br /> STORMWATER SYST M DEVELOPMENT FEES: TRAFFIC MITI TION FEES: <br /> ® YES, ❑ See Att. hed for calculations/credit ❑YES,Tra c Mitigation Total: $ <br /> To be added on • 2(n$-Q re°,S To be added on ❑ e Attached for calculations/credit <br /> Quantity charge(-7.9) SF Quantity charged SF ® NOT EQUIRED <br /> QTY is❑ Gro nd only❑ all surfaces QTY is❑ Roof only❑ all surfaces <br /> $_ZR.9 <br /> ❑ NOT REQUI' D <br /> Additional Checklists: <br /> ADDRESS LETTE REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑ YES-TYPE. SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> ❑ See At ched Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digit copy attached to permit record, Permit# <br /> ❑ Sa d to Address Folder in Development Tech File <br /> ® NOT EQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES-Type <br /> ® NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ® YES, Permit#PW 2/02-p c 9 <br /> 8 Stormwater NPDES Tab Completed in TRAKiT gj ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: 6:7 -r$ea !!o..,/` Date: n6 - 30 -202 Z. <br /> Worksheet Completed By: VV Date: <br /> REVISED 12/22/2021 <br />