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� PUBLIC WORKS <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) <br />PROJECT ADDRESS: �607 SE EVERETT MALL WAY STE D <br />DESCRIPTION OF WORK: HAIR SALON TI-HAIR STAR <br />CONTACT INFORMATION: <br />OWNER: APPLICANT: <br />NAME: ROBINSON PROPERTIES & INC LLC NAME: <br />ADDRESS: 500 SE EVERETT MALL WY #A7 ADDRESS <br />EVERETT, VVA, 98208 <br />PHONE: <br />EMAIL: <br />CONTACT: ❑ Owner ❑ Ap��licant ❑Other <br />NAME: [ContactNarne] <br />PHONE: [ContactPhone] <br />EMAIL: fContactEmaill <br />COMMENTS FROM PUBLIC WORFCS REVIEWER: <br />PW Permit Required? ❑ YES „� NO <br />Notes: <br />PHONE <br />EMAIL: <br />Date: <br />Permit #: <br />��� <br />3/11/2016 <br />B1603-039 <br />[AppName] <br />[AppAdd] <br />[AppCi], [AppSt], [AppZip] <br />[AppPhone] <br />[AppEmail] <br />LAND USE PROJECT #: <br />W.O. #: <br />Associated BIdg./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: L�� h f �`�o�v' <br />(Note: Counter Staff fo Create Utilit;✓ 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 Seivice, Size ❑ 3/4" Detect Meter Only, ❑ Fire Service Size <br />� NO ❑ NO <br />Explanation: Explanation: <br />❑ Water Department Cost Estimzite 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 $ <br />� NO <br />Explanation: <br />Existing Utility Permit # (if applicable): <br />� New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br />SYSTEM DEVELOPMENT FEE� �5fc fiev�sJ Gf X/(uC>Z .� C�� ^�'� g��� �� <br />� YES — Amount $ _ ❑ See Attached Spreadsheet ` C�' 3 7/ <br />❑ NO — No Change of Use / Other_ � 3� �� <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 />Qd N O <br />L i,�� <br />C r�d;-f ��`" � <br />O w'� <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 />.�LL�, �C�-C.�`L�-- �"?� � /W <br />Public Works Review r Signature Date <br />