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EVE R E T T PUBLIC WORKS REVIEW W <br /> WASHINGTON ORKSHEET <br /> PROJECT ADDRESS: 1722 100TH ST SW Permit#: B2207-092 <br /> DESCRIPTION OF WORK: NEW SFR&DRIVEWAY-LOT A,WEST HOUSE <br /> PW Reviewer to select all that appjZ 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 E New Connection, Size 3/4"-❑ Per Cost Estimate <br /> ❑ Alteration <br /> ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ Repair E Water System Development Fee Total: $4311.00 <br /> ❑ Cap-off, quantity ❑ Sewer System Development Fee Total:$ <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# i1�lWr(Wflo �Ww Q,{5mcf Explanation/Utility Permit# <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size <br /> ❑ Meter Only, Size El New Connection, Size -❑ Per Cost Estimate <br /> ❑ %" Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total:$ ❑ Backflow Prevention(Outside Building): ❑DCDA <br /> ❑ Backflow Prevention(Outside Building): ❑DCVA E NOT REQUIRED <br /> ® NOT REQUIRED Explanation/Utility Permit# <br /> Explanation/Utility Permit# <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/fyes, PWReviewerto send cost estimate requestto Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> E 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 /> E 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 E YES,Traffic Mitigation Total: $4993.00 <br /> To be added on PW To be added on ❑See Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF ❑NOT REQUIRED <br /> QTY is ❑ Ground only❑ all surfaces QTY is❑ Roof only❑all surfaces <br /> E NOT REQUIRED MCA A-CA Oh OW <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br /> E YES—TYPE: E SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY ❑ COMMERCIAL <br /> E See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> E Digital copy attached to permit record, Permit#132207-091 <br /> E Saved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> E NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> E YES, Permit#PW2207-024 <br /> E Stormwater NPDES Tab Completed in TRAKiT E ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED t, <br /> Worksheet Completed By: 1�/I/VI� Date: a3L b L Zt2) <br /> Worksheet Completed By: Date: <br /> REVISED 10/07/2022 <br />