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EVERETT PUBLIC WORKS REVI E <br /> WASHINGTON W WORKSHEET <br /> PROJECT ADDRESS: 9554 7TH AVE SE Permit#: B2403-078 <br /> DESCRIPTION OF WORK: NEW SINGLE FAMILY HOME-RB2306-001 THELON-CHELSEA HEIGHTS 16 <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 <br /> ❑ Repair ® Meter Only,Size 1 inch-❑Per Cost Estimate <br /> ® Water System Development Fee Total:$4,577.00 <br /> ❑ Cap-off,quantity <br /> ❑ Reconnection to stub ® Sewer System Development Fee Total:$4,028.00 <br /> ® Water Service Line(behind meter),Size i inch <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building):❑RPBA ❑DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED <br /> Explanation/Utility Permit# Explanation/Utility Permit# <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Requestfor Reference) <br /> ❑ New Connection,Size <br /> ❑ New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> ❑ Water System Development Fee Total:$ ❑ 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 B2403-078 ®See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 1472SF ❑ NOT REQUIRED <br /> QTY is❑Ground only❑all surfaces QTY is® Roof only❑all surfaces <br /> $ $439.83 <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 PWClerical@everettwo.gov) <br /> ®Digital copy attached to permit record,Permit#B2403-078 <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#PW2404-006 <br /> ®Stormwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: l eyze Oazoeetam Date:04/01/2024 <br /> Worksheet Reviewed By:T� / Date:—j?�//0//2-3 Zy <br />