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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4326 CRESCENT AVE Ilemnit#: PW2103-018 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: UTILITY AND STORM DRAINAGE FOR 3-LOT SHORT PLAT <br /> PW Reviewer to select all that aiviv 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 /> pr New Connection to main plus connections to building �f New Connection, Size I " -❑ Per Cost Estimate <br /> ❑Alteration ❑Meter Only, Size - ❑ Per Cost Estimate <br /> ❑ Repair ❑Water System Development Fee Total: $ <br /> ❑ Cap-off,quantity 3,Z(r p _5 ❑ Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0- ❑Water Service Line(behind meter), Size <br /> ❑ Backwater Valve t ---- ❑ Backflow Prevention (Outside Building): ❑ RPBA or❑ DCVA <br /> ❑ NOT REQUIRED2�b ❑ NOT REQUIRED <br /> Explanation/Utility Permit#: A A:-�l.�J �'� s01 1 explanation/Utility Permit M t) �]iZG — �Z5 <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 IWNOT REQUIRED <br /> l VNOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit M <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 /> NOT REQUIRED <br /> Bu- ding Permits (Note:Permit Technieien o add all items sel�d below to�ssociated Building Permit) <br /> S ORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> YES, lb-See Attached for calculations/credit ❑YES,Traffic Mitigation Total: $ <br /> To be added on PW Zt 03-c> I 0 To be add ?dne�� ❑ See Attached for calculations/credit <br /> Quantity charged 3 v 2 SF Quantity ed SF q NOT REQUIRED <br /> QTY is[KGround only all hard surfaces QTY is oof only❑all hard surfaces <br /> $ $ <br /> NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout 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 /> [jNOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> 0,NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ;YES, Permit#PW 2-10 3-61 <br /> g-Stormwater NPDES Tab Completed in TRAKiT O ADA Tab Completed in TRAKiT I�klnspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed Date: O 4- a 2 22 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />