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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 2505 MADISON ST Permit#: B2309-019 <br /> DESCRIPTION OF WORK: NEW ADU-CLOSE IN BASEMENT STAIRWELL,FRAME(2)BEDS,KITCHEN <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 - ❑Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only,Size -❑ Per Cost Estimate <br /> ❑ Repair ❑ Water System Development Fee Total:$ <br /> ❑ Cap-off,quantity ❑ Sewer System Development Fee Total:$ <br /> ❑ Reconnection to stub ❑ Water Service Line(behind meter),Size <br /> ❑ Backwater-Valve ❑ Backflow Prevention(Outside Building):❑RPBA ❑ DCVA <br /> Z NOT REQUIRE-,, ® NOT REQUIRED <br /> 'Explanation/-Utility Permit# Explanation/Utility Permit# <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 /> plaaation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes,PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes,-Qua.ntt4_ ,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-Prevertirnr side Building): ❑DCVA(far Domestic service) ❑RPBA(for Domestic service) ❑D CDA(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:$ <br /> To be added on PW To be added on <br /> See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF ❑ NOT REQUIRED <br /> QTY is❑Ground only❑all surfaces QTY is❑ Roof only❑all surfaces <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#62309-019 <br /> ®Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑--YES-Type _---, <br /> '® NOT REQUIRED;' <br /> '—Reason r�"- <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑ YES,Permit#PW <br /> ❑5'tormwater--NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑Inspections Added in TRAKiT <br /> ® NOT REQUIRED <br /> Worksheet Completed By: /PJ11ZG Date:09113190-93 <br /> Worksheet Reviewed By. Date: `� 13 ��'z 3 <br />