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4677 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/24/2017 <br /> Permit#: B1702-052 <br /> PROJECT ADDRESS: 1110 POPLAR ST <br /> DESCRIPTION OF WORK: TRANSFER PORTABLE CLASSROOM TO ELEMENTARY SITE INCL <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: EVERETT SCHOOL DIST 2 NAME: [AppName] <br /> ADDRESS: 4730 COLBY AVE ADDRESS: [AppAdd] <br /> EVERETT,WA, 98203 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? 0 YES ,(NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> "NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑YES—Amount$ 0 YES—Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0%" Detect Meter Only, 0 Fire Service Size <br /> 'NO ❑ NO <br /> xplanation: Explanation: <br /> ❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> ❑Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> ❑YES—Amount$ 0 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> NO <br /> � <br /> E planation: <br /> Existing Utility Permit#(if applicable): 'pco.L n t <br /> SYSTEM DEVELOPMENT FEE? 44. Tv4 of S-'fc�.oe� I� ©rfat <br /> RYES—Amount$ 2 7 7 3 0 See Attached Spreadsheet 1 24 x t t i s,rs4 6?etc() <br /> 0 NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) �{, <br /> TRAFFIC MITIGATION FEE? oO 5?4,`�' Por fa ( <br /> YES—Amount$ 2.6420 e 0 See Attached Spreadsheet <br /> CI NO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE 0 See Attached Letter <br /> XNO <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />