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LE EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> mom WASHINGTON <br /> PROJECT ADDRESS: 8102 EVERGREEN WAY BLDG E Permit#: B2010-052 <br /> TENANT: FOUR CORNERS APTS-BLDG E <br /> DESCRIPTION OF WORK: FOUR CORNERS APTS-BLDG E-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 0 New Connection,Size -0 Per Cost Estimate <br /> ❑Alteration Meter Only,Size 4" - 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 ❑Water Service Line(behind meter),Size TIFI To PW7011-044 <br /> ❑Backwater Valve I 0 Backflow Prevention(Outside Building): 0 RPBA or 0 DCVA <br /> 0 NOT REQUIRED "n 1m ©71) 0 NOT REQUIRED <br /> Explanation/Utility Permit#: 11�C,IV �v 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 ❑3/4'Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 Backflow Prevention(Outside Building): ❑DCDA <br /> ❑Backflow Prevention(Outside Building): 0 DCVA KNOT REQUIRED <br /> KNOT REQUIRED Explanation/Utility Permit#:FIRE SERVICE FROM PRIVATE MAIN <br /> Explanation/Utility Permit#: THROUGH SITE FED BROM BLDG B <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Departmen <br /> K Yes,Quantity 1 ,See attached for reference.4" meter estimate <br /> ❑NOT REQUIRED <br /> l Um g Pe its (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Backflow Prevention (Inside Building): K DCVA(for Domestic service) ❑RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> ❑NOT REQUIRED PS DI- D3q <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 /> XYES,K See Attached for calculations/credit 0 YES,Traffic Mitigation Total:$ <br /> To be added on PW To be added on B2010-052 ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 29,589 SF K NOT REQUIRED Credit from previous use <br /> QTY is❑Ground only 0 all hard surfaces QTY is K Roof only 0 all hard surfaces <br /> $ $ 7,790.78 <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 /> K YES—TYPE: 0 SFR ❑DUPLEX 0 ADU 0 INFILL DWELLING K MULTI-FAMILY 0 COMMERCIAL <br /> K See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits,scan one copy to Jeffrey Marks) <br /> K Digital copy attached to permit record, Permit# PW2011-044 <br /> K Saved to Address Folder in Development Tech File <br /> ❑NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> OYES—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 /> X YES, Permit#PW PW2011-044 <br /> K Stormwater NPDES Tab Completed in TRAKiT K ADA Tab Completed in TRAKiT K Inspections Added in TRAKiT <br /> ❑NOT REQUIRED <br /> Worksheet Completed By: ! .�.7 Date: 07/28/2021 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />