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NEN EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 8102 EVERGREEN WAY BLDG D Permit#: B2010-051 <br /> TENANT: FOUR CORNERS APTS-BLDG D <br /> DESCRIPTION OF WORK: FOUR CORNERS APTS-BLDG D-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 /> X New Connection to main plus 1 connections to building ❑New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration /. Meter Only,Size 4" -E Per Cost Estimate <br /> ❑ Repair / 0 Water System Development Fee Total:$SYS.DEV. FEES <br /> ❑Cap-off,quantity ❑Sewer System Development Fee Total:SON UTILITY PERMIT <br /> ❑ Reconnection to stub ❑Water Service Line(behind meter),Size TIED TO PW2011-044 <br /> ❑Backwater Valve 0 Backflow Prevention(Outside Building): ❑ RPBA or❑DCVA <br /> ❑NOT REQUIRED 7 ❑NOT REQUIRED <br /> Explanation/Utility Permit#: '�1` 69.4 Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑New Connection,Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Meter Only,Size 0 3/"Detect Meter Only,Service Size <br /> ❑Water System Development Fee Total:$ 0 Backflow Prevention(Outside Building): 0 DCDA <br /> ❑Backflow Prevention (Outside Building): 0 DCVA ONOT REQUIRED <br /> ONOT REQUIRED Explanation/Utility Permit#: FIRE SERVICE FROM PRIVATE MAIN <br /> Explanation/Utility Permit#: THROUGH SITE FED BROM BLDG B <br /> PUMP R OM <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Departmen <br /> (Yes,Quantity 1 ,See attached for reference.4"meter estimate <br /> ❑NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> g Backflow Prevention (Inside Building): X DCVA(for Domestic service) 0 PBA(for Domestic service) 0 DCDA(for Fire service) <br /> CINOT REQUIRED �21 (5 _o$1 <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> OYES,OSee Attached for calculations/credit 0 YES,Traffic Mitigation Total:$ <br /> To be added on PW To be added on B2010-051 ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 25,803 SF X NOT REQUIRED Credit from previous use <br /> QTY is 0 Ground only❑all hard surfaces QTY is X Roof only 0 all hard surfaces <br /> $ $ 6,793.93 <br /> 0 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 /> g YES—TYPE: 0 SFR ❑DUPLEX 0 ADU 0 INFILL DWELLING E MULTI-FAMILY 0 COMMERCIAL <br /> lit See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits,scan one copy to Jeffrey Marks) <br /> JS(Digital copy attached to permit record, Permit# PW2011-044 <br /> E Saved to Address Folder in Development Tech File <br /> ❑NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> EYES—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 /> EYES, Permit#PW PW2011-044 <br /> 0Stormwater NPDES Tab Completed in TRAKiT DADA Tab Completed in TRAKiT Inspections Added in TRAKiT <br /> ❑NOT REQUIRED <br /> Worksheet Completed By: 7 ��-,D Date: 07/28/202-1. <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />