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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/11/2016 <br /> Permit#: C1603-022 <br /> PROJECT ADDRESS: 10415 ROSEWOOD AVE r � �� <br /> � �� � <br /> DESCRIPTION OF WORK: ADD LAUNDRY, RESTROOM &STORAGE <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: TSINKEVICH VITALIY S/PASHKO A NAME: TSINKEVICH VITALIY S/PASHKO A <br /> ADDRESS: 10415 ROSEWOOD AVE ADDRESS: 10415 ROSEWOOD AVE <br /> EVERETT,WA, 98204-3620 EVERETT,WA, 98204-3620 <br /> PHONE: 4256283358 PHONE: 4256283358 <br /> EMAIL: WA98204@GMAIL.COM EMAIL: WA98204@GMAIL.COM <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: TSINKEVICH VITALIY S/PASHKO A <br /> PHONE: 4256283358 <br /> EMAIL: WA98204@GMAIL.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? ❑ YES � NO w.0.#: <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 /> �l N O <br /> Explanation: <br /> (Note: Counter Staff to Creafe Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑ YES—Amount$ ❑ YES—Amount$ <br /> ❑ Meter Only, ❑ Complete Service, Size ❑ '/<" Detect Meter Only, ❑ Fire Service Size <br /> �J NO ❑ NO <br /> Explanation: Explanation:_ <br /> ❑ Water Department Cost Estimate Needed-(If 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$ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> � NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENTFEE? <br /> ❑ YES—Amount$ ❑ See Attached Spreadsheet <br /> � 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? <br /> � YES—Amount$ ❑ See Attached Spreadsheet <br /> � NO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑ YES—TYPE ❑ See Attached Letter <br /> � NO <br /> � �� r`�c9�✓L��'L_— J-' �<'i'- �Sc, <br /> Public Works Reviewer Signature Date <br /> REVISED Z24/2016 <br />