1222 LOMBARD AVE 2025-10-06 - Laserfiche WebLink

E V E R E T T PUBLIC WORKS REVIEW WORKSHEET WASHINGTON PROJECT ADDRESS: 1222 LOMBARD AVE Permit#: 131908-028 TENANT: [TenName] DESCRIPTION OF WORK: REMODEL EXISTING HOUSE AND ADD AN ADDITION 44X35 PW Reviewer to select all that apply below: Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) ❑ New Connection to main plus connections to building ❑ New Connection, Size - ❑ Per Cost Estimate ❑Alteration ❑ Meter Only, Size - ❑ Per Cost Estimate ❑ Repair ❑Water System Development Fee Total: $ ❑ Cap-off, quantity ❑Sewer System Development Fee Total:$ ❑ Reconnection to stub ❑Water Service Line(behind meter), Size ❑ Backwater Valve ❑ Backflow Prevention(Outside Building): ❑ RPBA or❑ DCVA /fkNOT REQUIRED tZNOT REQUIRED Explanation/Utility Permit#: Explanation/Utility Permit#: IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) ❑ New Connection, Size ❑ New Connection, Size -❑ Per Cost Estimate ❑Meter Only, Size 10%" Detect Meter Only, Service Size ❑Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): ❑ DCDA ❑ Backflow Prevention (Outside Building): ❑ DCVA NOT REQUIRED )O- REQUIRED Explanation/Utility Permit#: Explanation/Utility Permit#: WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) ❑Yes, Quantity See attached for reference. aNOT REQUIRED Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) ❑ Backflow Prevention (Inside Building): ❑ DCVA(for Domestic service) ❑ RPBA(for Domestic service) ❑ DCDA(for Fire service) ®-NOT REQUIRED Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) STORMWATER SYSTEM DEVELOPMENT F S: TRAFFIC MITIGATION FEES: ES, Stormwater Total: $ $ t1 BI�O�'�28 ❑YES, Traffic Mitigation Total:$ fMoof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) ❑ See Attached for calculations/credit ❑All Hard Surface Fees to be added to Permit# NOT REQUIRED Of-See Attached Spreadsheet for calculations/credit ❑ NOT REQUIRED Additional Checklists: ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) ❑YES—TYPE: ❑SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL ❑ See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) ❑ Digital copy attached to permit record, Permit# ❑ Saved to Address Folder in Development Tech File XJNOT REQUIRED FIRE SPRINKLERS REQUIRED? ❑YES—Type ANOT REQUIRED Reason: PUBLIC WORKS PERMIT REQUIRED? ES, Permit#PW I l 0 17- p 93 XStormwater NPDES Tab Completed in TRAKiT WADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT ❑ NOT REQUIRED Worksheet Completed By: d 1 Date: Worksheet Checked By: Date: r REVISED 412412019