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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4326 CRESCENT AVE =it#: PW2103-018 <br /> TENANT: [TenName] t-{4u <br /> DESCRIPTION OF WORK: UTILITY AND STORM DRAINAGE FOR 3-LOT SHORT PLAT <br /> PW Reviewer to select all that a 1 below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Pen-nit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation &Cost Est.) <br /> P'New Connection to main plus ( connections to building New Connection, Size ( -❑ Per Cost Estimate <br /> ❑Alteration �( 3 f:on- 3 L-+-c�f. ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ❑Water System Development Fee Total:$ <br /> ❑ Cap-off, quantity 3,2.(ro GS • ❑ Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub V 90 M-ro- ❑Water Service Line(behind meter),Size <br /> ❑ Backwater Valve ❑ Backflow Prevention (Outside Building): ❑ RPBA or❑ DCVA <br /> ❑ NOT REQUIRED C Z�v'� ❑ NOT REQUIRED ,,�, c (� <br /> Explanation/Utility Permit#: C�r z-y`-1 f you 3 Explanation/Utility Permit#: �12_I ':1'-�Z v <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 ❑%" Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑DCVA IIWNOT REQUIRED <br /> IWNOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/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 /> 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 /> V.NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> ST RNiW TER SYSTEM DEVELOPM�k FEES: TRAFFIC MITIGATION FEES: <br /> ES, IN-See Attached for calculations/cre i ❑YES,Traffic Mitigation Total:$ <br /> To be added on PW 2-1 03-o 116 be o ❑ See Attached for calculations/credit <br /> Quantity charged v 2(o SF Q ntity charged SF [KNOT REQUIRED <br /> QTY is [Ground only all hard surfaces QT is❑ Roof only❑all hard surfaces <br /> $ 4-tl.0 � $ <br /> NOT REQUIRED <br /> Ad zonal Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes-( ew 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 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 /> EX NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> 0NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW 210 3-a1 <br /> Pbtormwater NPDES Tab Completed in TRAKiT QCADA Tab Completed in TRAKiT 104nspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By✓�' �. Date: 04 02 �22 <br /> Worksheet Checked By: Date: <br /> REVISED 1112712019 <br />