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EVERETT PUBLIC WORKS ORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 2600 FEDERAL AVE BREAKROOM <br /> Permit#: B2201-015 <br /> TENANT: MODULAR BREAKROOM BUILDING <br /> DESCRIPTION OF WORK: MODULAR BREAKROOM 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 connections to building ❑ New Connection, Size <br /> ❑Alteration -❑ Per Cost Estimate <br /> ❑ Repair ❑ Meter Only, Size - ❑ Per Cost Estimate <br /> p ❑ Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity ❑ Sewer System Development Fee Total:❑ Reconnection v stub $ <br /> ❑ Backwater Valve ❑ Water Service Line (behind meter), Size <br /> e❑ NOT REQUIRED P�.NOT REQUIRED❑ Backflow Prevention (Outside Building): ❑ RPBA or❑ DCVA <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE- (Not Including Cost Estimates <br /> FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Connection, Size -❑ Per Cost Estimate <br /> ❑ Meter Only, Size ❑3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑ DCVA ETNOT REQUIRED <br /> Q.NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/fyes, 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 /> 0 NOT REQUIRED <br /> Building Permits (Note:Pen-nit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> 0-YES, Q See Attached for calculations/credit _ _ ❑YES,Traffic Mitigation Total: $ <br /> To be added on PW To be added on -- - ❑ See Attached for calculations/credit <br /> Quantity charged SF Quantity charged _ - SF KNOT REQUIRED <br /> QTY is ❑ Ground only❑all hard surfaces QTY is aRoof only❑all hard surfaces <br /> $ $ <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 Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> ❑ Saved to Address Folder in Development Tech File <br /> El NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES-Type <br /> E3.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 /> IANOT REQUIRED !'v�+2t�'L o L 5 F+� :1►a*� .SS.��� <br /> Worksheet Completed By: <br /> Date: n2-&T I za Z Z. <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />