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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 4020 HOYT AVE Permit#: B2112-050 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: CONVERT EXTG GARAGE LOFT INTO ACCESSORY DWELLING UNIT <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 <br /> ❑ NOT REQUIRED ( 9) ❑ ❑ DCVA <br /> ❑ NOT REQUIRED <br /> Explanation/Utility Permit#_�Ao3-OZc 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 <br /> ❑ Meter Only, Size -El Per Cost Estimate <br /> y, ❑ %" 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 /> Explanation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> Ej 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 /> M NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> ST, WATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> �ES, Q See Attached for calculations/credit ❑YES,Traffic Mitigation Total: $ <br /> To be added on PW 2303-oo' To be added on <br /> ❑See Attached for calculations/credit <br /> Quantity charged+f0 SF Quantity charged SF PNOT REQUIRED <br /> QTY is[,Ground only❑ all surfaces QTY is❑ Roof only❑ all surfaces <br /> $ ,� S•S 4 <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 /> [aYES-TYPE: ❑ SFR ❑ DUPLEX Vf 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# $21+2'050 <br /> Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES-Type <br /> NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> Ed-YES, Permit#PW 2.3a3-co t <br /> 21" ormwater NPDES Tab Completed in TRAKiT EJADA Tab Completed in TRAKiT [-] Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: <br /> Worksheet Completed By: Date: <br /> REVISED 12/2Z2021 <br />