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EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 9526 7TH AVE SE Permit#: B2403-076 <br /> DESCRIPTION OF WORK: NEW SINGLE FAMILY HOME-RB2306-001 THELON-CHELSEA HEIGHTS 07 <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 <br /> ❑ Alteration VU Meter Only,Size 1 inch-❑Per Cost Estimate <br /> ❑ Repair Water System Development Fee Total:$4,577.00 <br /> ❑ Cap-off,quantity Sewer System Development Fee Total:$4,028.00 <br /> ❑ Reconnection to stub Water Service Line(behind meter),Size 1 inch <br /> ❑ Backwater Valve 1,� n ❑ Backflow Prevention(Outside Building):❑RPBA ❑ DCVA <br /> NOT <br /> ❑ E planattiUIREDion/Uttility Permit# "►�l"V�I ❑ Explanation/Utility <br /> REQUIRED �A 1 I D�j <br /> Ex lanation/Utility Permit# V`�M D�r <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size ❑ New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ ❑ 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-(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 /> 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 B2403-076 ®See Attached for calculations/cre <br /> j�w <br /> Quantity charged SF Quantity charged 1305SF ❑ NOT REQUIRED <br /> QTY is❑Ground only❑all surfaces QTY is® of only❑all surfaces <br /> $0.00 389.93 j <br /> ❑ NOT REQUIRED v 00�, <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 PWClerical@everettwo.gov) <br /> ®Digital copy attached to permit record,Permit#R2t/O 3—l7 (� <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#PW2403-028 <br /> ®Stormwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRAKiT [:] inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: 7ew Date:0319719024 <br /> Worksheet Reviewed By:" / Date: <br /> Z <br />