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EVE R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 8102 EVERGREEN WAY BLDG A Permit#: B2010-048 <br /> TENANT: FOUR CORNERS APTS-BLDG A <br /> DESCRIPTION OF WORK: FOUR CORNERS APTS-BLDG A-5 OVER 1 MULTIFAMILY RESID BLDG <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 /> r(New Connection to main plus 1 connections to building 0 New Connection, Size - ❑ Per Cost Estimate <br /> ❑Alteration X Meter Only, Size 4" -X Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $SYS. DEV. FEES <br /> ❑ Cap-off, quantity 0 Sewer System Development Fee Total: $ON UTILITY PERMIT <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size TIED TO PW7011-044 <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED ' �l��I _ 2 0 NOT REQUIRED <br /> Explanation/Utility Permit#: A l b Explanation/Utility Permit#: <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 ❑3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA ? (NOT REQUIRED <br /> (NOT REQUIRED Explanation/Utility Permit#: FIRE SERVICE FROM PRIVATE MAIN <br /> Explanation/Utility Permit#: THROUGH SITE FED BROM BLDG B <br /> PUMP RO M <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate reques o a er Department) <br /> 0 Yes, Quantity 1 , See attached for reference.4" meter estimate <br /> NOT REQUIRED <br /> `J ve <br /> Plumbing er s ote:Permit Technicians to a all items selected below to Plumbing Permit-for items inside building only) <br /> X Backflow Preventio (Inside Building : X DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA (for Fire service) <br /> ❑ NOT REQUIRED �21��, D <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> EYES,X See Attached for calculations/credit 0 YES, Traffic Mitigation Total: $ <br /> To be added on PW To be added on B2010-048 0 See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 19,718 SF 0 NOT REQUIRED Credit from previous use <br /> QTY is 0 Ground only❑ all hard surfaces QTY is)8(Roof only ❑all hard surfaces <br /> $ $ 5,191.75 <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES—TYPE: ❑ SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING 0 MULTI-FAMILY ❑ COMMERCIAL <br /> X 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# PW2011-044 <br /> )S(Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> RYES—Type NFPA 13 <br /> ❑ NOT REQUIRED <br /> Reason: FIRE SERVICE FROM PRIVATE MAIN THROUGH SITE FED BROM BLDG B PUMP ROOM <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> )8(YES, Permit#PW PW2011-044 <br /> XStormwater NPDES Tab Completed in TRAKiT )S(ADA Tab Completed in TRAKiT X Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: 7 t! �.�4.' Date: 0 /22/2021 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />