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PUBLIC WORKS <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) Date: 5/3/2016 <br />Permit #: 61605-007 <br />PROJECT ADDRESS: <br />DESCRIPTION OF WORK: <br />2006 HIGHLAND AVE <br />FIRE DAMAGE REPAIR <br />CONTACT INFORMATION: <br />OWNER: <br />NAME: HARPER LORA L <br />ADDRESS: 2006 HIGHLAND AVE <br />EVERETT, WA, 98201 <br />PHONE: <br />EMAIL: <br />CONTACT: � Owner ❑ Applicant ❑Other <br />NAME: [ContactName] <br />PHONE: [ContactPhone] <br />EMAIL: [ContactEmail] <br />COMMENTS FROM PUBLIC WORKS REVIEWER: <br />PW Permit Required? ❑ YES �NO <br />Notes: �l"�5�, r�(,���► �'� ��'�'I�77,c1n Cr► �'l�C{ !'�2inr�t- {�r- <br />:� ri� n�� c� � c�i .bv� s l�'. fll c��.� iYis,r�ra�t<�-� ✓'��A » �'b��6 . <br />APPLICANT: <br />NAME: <br />ADDRESS <br />PHONE: <br />EMAIL: <br />[AppName] <br />[AppAdd] <br />LApPC�L IAppStl, LAPpZ�pl <br />[AppPhone] <br />[AppEmail] <br />LAND USE PROJECT #: <br />W.O. #: <br />Associated Bldg./PW Permit #: <br />�—� <br />�- <br />1 <br />FIRE SPRINKLER REQUIRED? (bv Fire DepartmenUCode) " <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 $ ❑ YES — Amount $ <br />❑ Meter Only, ❑ Complete Service, Size ❑ 3/4' Detect Meter Only, <br />�( N O <br />Explanation: <br />.� N O <br />Explanation: <br />❑ Fire Service Size <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 aE�plicable): <br />SEWER FEE? <br />❑ YES — Amount $ <br />�NO <br />Explanation: <br />Existing Utility Permit # (if applicable): <br />SYSTEM DEVELOPMENTFEE? <br />❑ YES — Amount $ <br />�3(NO — No Change of Use / Other <br />Explanation: <br />❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br />❑ See Attached Spreadsheet <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 />l�N O <br />` �,�'j1r2 - c �2 , / � 0 � <br />Public Works Reviewer Signature ate <br />REVISED 2/24/2016 <br />