Laserfiche WebLink
`EVERETT <br />WASHINGTON <br />PUBLIC WORKS REMW WORKSHEET <br />PROJECT ADDRESS: 3825 COLBY AVE P mit #: BW2012-002 <br />TENANT: [TenName] <br />i <br />DESCRIPTION OF WORK: SFR REMODEL TO ABATE UNPERMITTED A RATIONS <br />PW Reviewer to select all that aooly below: <br />(Note: Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br />New Connection to main plus connections to building <br />Alteration <br />Repair <br />❑ Cap -off, qu 'n _ <br />❑ Reconn ion to stub <br />❑ Back ter Valve <br />® NO REQUIRED <br />Expl ation/Utility Permit # _ <br />DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br />❑ New Connection, Size _ - ❑ Per Cost Estimate <br />❑ Meter Only, Size = ❑ Per Cost Estimate <br />❑ Water System Development Fee Total: $_ <br />❑ Sewer System Development Fee Total: $ <br />❑ Water Servi Line (behind meter), Size <br />❑ Backflo revention (Outside Building): ❑RPBA ❑ DCVA <br />�] NO EQUIRED <br />Explanation/Utility Permit # <br />LIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate /Request for Reference) <br />New Connection, Size _ ❑ New Connect' n, Size ❑ Per Cost Estimate <br />Meter On ,Size _ ❑ '/4' Detect ter Only, Service Size <br />Water stem Development Fee Total: $ ❑ Backfl Prevention (Outside Building): ❑DCDA <br />Bac ow Prevention (Outside Building): ❑DCVA NO EQUIRED <br />N. REQUIRED Explanation/Utility Permit#_ <br />pla/DERTMENTCOST <br />lity Permit # <br />,TER ESTIMATE NEEDED-(Ifyes, PWReviewerto send cost estimate requestto Water Department) <br />Yes, , See attached for reference. <br />NOTD <br />1itS (Note: Permit Technicians to add all items selected below to Plumbing Permit -for items inside building only) <br />(Inside Building): ❑DCVA (for Domestic service) QRPZA (for Domestic service) ❑DCDA (for Fire service) <br />IUIRED <br />Permits (Note: Permit Technicians to add all items selected below to <br />YES, I I See Attached for calculations / credit <br />To be added on PW To be added on j—W-2.b12-COZ <br />Quantity charged _SF Quantity charged jfe_SF <br />QTY is ❑ Ground only ❑ all surfaces QTY is ® Roof only ❑ all surfaces <br />4l.'l$ <br />i7U7REQUiRED <br />Building Permit) <br />YES, raffic Mitigation Total: $ <br />See Attached for calculations/credit <br />NOT REQUIRED <br />Witional Checklists: <br />DRESS LETTER REQUIRED? (If yes (new assigned address), print out A ess Letter from TRAKiT Print Menu and include) <br />YES -TYPE: ❑SFR ❑DUPLEX ❑ ADU ❑ INFILL DWELL G ❑ MULTI -FAMILY ❑ COMMERCIAL <br />❑ See Attac d Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />❑ Digital c y attached to permit record, Permit #_ <br />❑ Save o Address Folder in Development Tech File <br />NOT R UIRED <br />NOT <br />YES, Permit # W_ <br />❑ Stormwa r NPDES Tab Completed in TRAKiT ❑ ADA Tab Completed in TRAKiT [:]Inspections Added in TRAKiT <br />NOT REQ RED <br />Worksheet Completed By:,AI%l/wr* Date: 6(# I j ri I20z-2- <br />Worksheet Completed By:79c;;��- Date: 0 (0 I <br />