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E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3326 ROCKEFELLER AVE Permit#: B2207-041 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: EXISTING GARAGE COVERTED TO DADU <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 /> R 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 2 ❑ Backflow Prevention (Outside Building): ❑RPBA ElDCVA <br /> NOT REQUIRED <br /> NOT REQUIRED <br /> Explanation/Utility an ton/UUt ity Permit#1� 03- 2 E❑xplann tion/Utility Permit# Lk 22_cq —03 2_ <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 ❑ 3/-; etect Meter Only, Service Size <br /> ❑ Water stem Development Fee Total:$ ❑ ackflow Prevention (Outside Building): ❑DCDA <br /> ❑ Ba flow Prevention (Outside Building): ❑DCVA NOT REQUIRED <br /> ® T REQUIRED Explanation/Utility Permit# <br /> Explanation/Utility Permit# <br /> WATER D ARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes uantity , See attached for reference. <br /> © T REQUIRED <br /> Plumbi Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> Backflo revention (Inside Building): ❑DCVA(for Domestic service) ❑RPBA(for Domestic service) ❑DCDA(for Fire service) <br /> T REQUIRED <br /> ( Uilding Permits (Note:Permit Technicians to add all item e d below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> YES, ❑ See Attached for calculations/credit ❑YES,Tra Mitigation Total: $ <br /> To be added on PW 1 -o1-01 To be add on ❑ e Attached for calculations/credit <br /> Quantity charged�_SF Quanti charged SF ® NO REQUIRED <br /> Qis 9 round only❑ all surfaces QTY s❑ Roof only❑ all surfaces <br /> E] NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Ad ress Letter from TRAKiT Print Menu and include) <br /> YES—TYPE: ❑ SFR ❑ DUPLEX E0 ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with pen-nits, scan one copy to Jeffrey Marks) <br /> Digital copy attached to permit record, Permit 04 <br /> ® Saved to Addr ss Folder in Development Tech File <br /> ❑ NOT REQUIR <br /> FIRE SPRIN ERS REQUIRED? <br /> ❑ YES— pe <br /> NOT EQUIRED <br /> Reaso <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> YES, Permit#PW n <br /> Stormwater NPDES Tab Completed in TRAKiT ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By Date:�j1i?/ I Z 2-- <br /> Worksheet Completed By: = r Date: 7 ZS 1 2022 <br /> REVISED 12/22/2021 <br />