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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON t <br /> PROJECT ADDRESS: 4326 CRESCENT AVE - it#: PW2103-018 <br /> TENANT: [TenName] A330 <br /> DESCRIPTION OF WORK: UTILITY AND STORM DRAINAGE FOR 3-LOT SHORT PLAT <br /> PW Reviewer to select all that auply 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 New Connection,Size I -❑ Per Cost Estimate <br /> ❑Alteration X Fon- 3 ._.a-r5 ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair ❑Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity 3,24Pc C-S ❑ Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub is 50 "-ro- ❑Water Service Line(behind meter),Size <br /> ❑ Backwater Valve � ❑ Backflow Prevention(Outside Building): ❑ RPBA or❑ DCVA <br /> ❑ NOT REQUIRED ?Z 3�you 3�❑ NOT REQUIRED ' (� �, p r� <br /> Explanation/Utility Permit#:~C�'1 �_" Explanation/Utility Permit#: -K.21��"l L� <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 KNOT REQUIRED <br /> KNOT REQUIRED Explanation/Utility Permit M <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(!f 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 /> gilding Permits (Note:Permit Tinian to add all items selected below to associated Building Permit) <br /> TORMW TER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> YES, -See Attached for calculations/credit ❑YES,Traffic Mitigation Total:$ <br /> To be added on PW 2-103-o I S To be a d d on ❑See Attached for calculations/credit <br /> Quantity charged vZ SF Quantity c arged - SF KNOT REQUIRED <br /> QTY is CGround only all hard surfaces QTY is Roof only❑all hard surfaces <br /> ?1.04- $ <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 /> KNOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> 0NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW 2-10 3-6115 <br /> �LStormwater NPDES Tab Completed in TRAKiT Q"DA Tab Completed in TRAKiT Odnspections Added i4TRA <br /> ❑ NOT REQUIRED <br /> Worksheet Completed Bye' �. Date: O 4- e, -Z6 <br /> Worksheet Checked By: Date: <br /> REVISED 1112712019 <br />