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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 2600 FEDERAL AVE RESTROOM Permit#: B2201-014 <br /> TENANT: MODULAR RESTROOM BUILDING <br /> DESCRIPTION OF WORK: MODULAR RESTROOM BUILDING WITH ACCESS RAMPS <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 i connections to building ❑ New Connection,Size -❑ Per Cost Estimate <br /> ❑Alteration Ameter Only, Size 2" -❑ Per Cost Estima e <br /> ❑ Repair bWater System Development Fee Total:$ <br /> ❑ Cap-off,quantity K-Sewer System Development Fee Total:$ <br /> ❑ Reconnection to stub Z Water Service Line(behind meter),Size 2 '' <br /> ❑ Backwater Valve )dBackflow Prevention(Outside Building): III RPBA or❑ DCVA <br /> ❑ NOT REQUIRED �1 1 ❑ NOT REQUIRED <br /> Explanation/Utility Permit M 22 b h b 1 Explanation/Utility Permit M 0 ZZ 62-o <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 O(NOT REQUIRED <br /> NOT REQUIRED Explanation/Utility Permit M <br /> xplanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(if yes, PW Reviewerto send cost estimate request to Water Department) <br /> ❑Yes, Quantity See attached for reference. <br /> 16 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 /> j'aNOT 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 /> AYES, ❑ See Attached for calculations/credit ❑YES,Traffic Mitigation Total:$ <br /> To be added on PW To be added on �3 2 Z O t —b 14 ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged 4&r, SF KNOT REQUIRED <br /> QTY is ❑ Ground only❑all hard surfaces QTY is gRoof only❑all hard surfaces <br /> $ $ i 'L3 . 19 <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout 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 Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> ❑ Saved to Address Folder in Development Tech File <br /> Id NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> 01 NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑ Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> �(NOTREQUIRED '7�N2rr2-a23 a`z.e4»Y ,ss�� <br /> Worksheet Completed B , r ,l �" Date: Z /712-0Z Z- <br /> Worksheet Checked By: Date: <br /> REVISED 1112712019 <br />