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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 1/14/2016 <br /> Permit#: B1601-024 <br /> PROJECT ADDRESS: 3015 21ST ST <br /> DESCRIPTION OF WORK: DETACHED GARAGE ON EXISTING SLAB/FOUNDATION <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: BURRUSS MICHAEL F NAME: [AppName] <br /> ADDRESS: 3015 21ST STREET ADDRESS: [AppAdd] <br /> EVERETT,WA, 98201 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? ❑ 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 FEE? <br /> ❑ YES—Amount$ ❑ Meter Only, ❑ Complete Service, Type/Size <br /> ❑ NO <br /> Explanation: <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 DEVELOPMENT FEE? <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 /> Public Works Reviewer Signature Date <br /> REVISED 1/5/2016 <br />