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E V E R E T T PUBLIC WORKS REVIEW <br /> WASHINGTON WORKSHEET <br /> PROJECT ADDRESS: 9570 7TH AVE SE Permit#: B2403-071 <br /> DESCRIPTION OF WORK: NEW SINGLE FAMILY HOME-RB2306-001 THELON-CHELSEA HEIGHTS 23 <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 /> ® New Connection to main plus 1 connections to building ❑ New Connection,Size - ❑ Per Cost Estimate I <br /> ❑ Alteration <br /> ® Meter Only,Size 1 inch-❑Per Cost Estimate <br /> ❑ Repair ® Water System Development Fee Total:$4,577.00 4. <br /> ❑ Cap-off,quantity V 10- <br /> ® Sewer System Development Fee Total:$4,028.00 <br /> ❑ Reconnection to stub ® Water Service Line(behind meter),Size 1 inch <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Buildin <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED g) ❑RPBA ❑DCVA <br /> Explanation/Utility Permit# Explanation/Utility Permit# <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size ❑ New Connection,Size -❑ Per Cost Estimate <br /> ❑ Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building):❑DCDA <br /> ❑ Backflow Prevention(Outside Building):❑DCVA ® NOT REQUIRED <br /> ® NOT REQUIRED Explanation/Utility Permit# <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 /> Building Permits(Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ® YES,®See Attached for calculations/credit ® YES,Traffic Mitigation Total:$5,592.00 <br /> To be added on PW To be added on B2403-071 ®See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 1504SF ❑ NOT REQUIRED <br /> QTY is❑Ground only❑all surfaces CITY is®Roof only❑all surfaces <br /> $ $449.40 <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 /> ® 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 PWClericol@everettwa.gov) <br /> ®Digital copy attached to permit record,Permit#B2403-071 <br /> ®Saved to Address Folder in Development Tech File <br /> ® NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ® YES Type 13D <br /> ❑ NOT REQUIRED <br /> Reason:Per note on civil plan <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ® YES,Permit#PW2404-015 <br /> ®Stormwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: 7CTIZG Date:04/02/2024 <br /> Worksheet Reviewed By:' / Date: OIL/ G 12 0 L`f <br />