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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 9592 7TH AVE SE Permit#: B2403-079 <br /> DESCRIPTION OF WORK: NEW SINGLE FAMILY HOME-RB2306-001 THELON-CHELSEA HEIGHTS 32 <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&Cos Est.) <br /> ® New Connection to main plus 1 connections to building✓ ❑ New Connection,Size - ❑ Per Cost Estima <br /> ❑ Alteration ® 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:$4,028.00 <br /> ❑ Reconnection to stub ® Water Service Line(behind meter),Size 1 inch <br /> ❑ Backwater Valve ❑ Backflow Prevention(Outside Building):❑RPBA ❑ DCVA <br /> NOT REQUIRED ❑ NOT REQUIRED <br /> planation/Utility Permit# Explanation/Utility Permit# u24OS- U 10 <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection,Size ❑ New Connection,Size -❑Per Cost Estimate <br /> ❑ Meter Only,Size ❑ %"Detect Meter Only,Service Size <br /> ❑ Wa r System Development Fee Total:$ ❑ ckflow Prevention(Outside Building):❑DCDA <br /> ❑ Ba flow Prevention(Outside Building):❑DCVA ® OT REQUIRED <br /> ® N T REQUIRED Explanation/Utility Permit# <br /> planation/Utility Permit# <br /> WATER EPARTMENT COST ESTIMATE NEEDED-(If yes,PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Ye Quantity.See attached for reference. <br /> ® N T REQUIRED <br /> Plumbin Permits(Note:Permit Technicians to add all items selected below to Plumbing Permit for items inside building only) <br /> Backflo Prevention(Inside Building): ❑DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> ® N 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/cr dit ® YES,Traffic Mitigation Total:$5,592.00✓ <br /> To be added on PW To be added on B2403-079 ®See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 1504SF ❑ NOT REQUIRED <br /> CITY is❑Ground only❑all surfaces QTY is®R9of 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 PWClerical@everettwa.gov) <br /> ®Digital copy attached to permit record,Permit#B2403-079 <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#PW2404-024 <br /> ®Stormwater NPDES Tab Completed in TRAKiT ®ADA Tab Completed in TRAKiT []Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: ?ene !&l feadm Date:0410412094 <br /> Worksheet Reviewed By:>Z Dater,- Zo 24 <br />