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EVE RETT PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROJECT ADDRESS: 1018 91ST PL SW Permit#: B2211-119 <br />TENANT: 1 b� <br />DESCRIPTION OF WORK: NEW CONSTRUCTION SFR P W /iZ 1 ' <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br />SANITARY SEWER: <br />❑ New Connection to main plus connections to building <br />❑ Alteration y� 1 m , <br />❑ Repair I `It/, <br />❑ Cap -off, quantity <br />it Reconnection to stub <br />❑ Backwater Valve <br />ED <br />Explanation/❑Utility Permit #: <br />IRRIGATION SERVICE: (Not Including Cost Estimates) <br />❑ New Connection, Size <br />❑ Meter Only, Size <br />❑ Water System Development Fee Total: $ <br />❑ Backflow Prevention (Outside Building): ❑ DCVA <br />19 NOT REQUIRED <br />Explanation/ Utility Permit M <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ Meter Only, Size ❑Per Cost 1AEstimate <br />A <br />❑ Water System Development Fee Total: $ r <br />❑ Sewer System Development Fee Total: $ MOL ra I `' <br />Water Service Line (behind meter), Size 3 n <br />❑ Backflow Prevention (Outside Building): D RPBA or O DCVA <br />❑ NOT REQUIRED <br />Explanation/ Utility Permit #: �i 1 <br />FIRE SERVICE: (Attach Cost Estimate / Request for Reference) <br />❑ New Connection, Size - ❑ Per Cost Estimate <br />❑ 3/4" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building): ❑ DCDA <br />Y NOT REQUIRED <br />Explanation/ Utility Permit #: <br />WATER DEPARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewerto send cost estimate request to Water Department) <br />❑ Yes, Quantity See attached for reference. <br />td NOT REQUIRED <br />Plumbing Permits (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />❑ Backflow Prevention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />Pf NOT REQUIRED <br />Building Permits (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />STORMWATER SYSTEM DEVELOPMENT FEES: <br />YES, ❑ See Attached (calculations / credit <br />To be added on PW L 1- 60& To be added on'0S?-0_M _ <br />Quantity charged SF Quantity charged Lla I I SF <br />QTY is IR Grourl�ggly O hard surfaces Q TY is of Rpoj only1fj' eat harmed surfaces <br />$ 4 1�I M WTI J <br />❑ NOT REQUIRED <br />Additional Checklists: <br />YES, Traffic Mitigation Total: $ <br />❑ See Attached for calculations / credit <br />NOT RIQUIRED <br />o,!SkWIl S <br />yYidl pGlyUll <br />DRESS LET ff RE UIRED? (if yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br />YES-TYPkjp§.F-W ❑ DUPLEX ❑ ADU ❑ INFILL DWELLING ❑ MULTI -FAMILY ❑ COMMERCIAL <br />See Mached 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 # WTI TI I - I \ <br />Saved to Address Folder in Development Tech File <br />NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES -Type <br />Vr NOT REQUIRED <br />VP BLIC WORKS PERMIT REQUIRED? <br />YES, Permit# PW'jVM'L-eFC:TW <br />❑ Stormwater NPDES Tab Completed in TRAKiT ❑ ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: Date: 1 L I d 14 <br />Worksheet Checked By:� Date: 12 �t 4'Zo Z 2 <br />REVISED 11272019 <br />