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EV E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 2623 GRAND AVE Permit#: B2312-027 <br /> DESCRIPTION OF WORK: DIVIDE EXISTING SFR INTO DUPLEX ADD WALLS,KITCHEN,BATHROOM <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 /> ® NOT REQUIRED ® NOT REQUIRED <br /> Explanation/Utility Permit# Explanation/Utility Permit# <br /> IRRIGATION SERVICE:(Not Including Cost Estimates) FIRE SERVICE:(Attach Cost Estimate/RequestforReference) <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 /> Explanation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes,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 /> ® 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:$4,993.00 <br /> To be added on PW To be added on ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF ❑ NOT REQUIRED dR 515'1 7 <br /> QTY is❑Ground only❑all surfaces QTY is❑Roof only❑all surfaces <br /> $ $ (ZoZY >FLA, ) <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 PWClericol@everettwa.gov) <br /> ® Digital copy attached to permit record,Permit# B2312-027 <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 /> ❑ YES,Permit#PW <br /> ❑Stormwater NPDES Tab Completed in TRAKiT ❑ADA Tab Completed in TRAKiT ❑Inspections Added in TRAK7 <br /> ® NOT REQUIRED <br /> Worksheet Completed By:)" ! Date: 12-26-2023 <br /> Worksheet Reviewed By:l /� Date: 12-26-2023 <br />