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OXT PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/19 3 <br /> Permit#: O7 <br /> PROJECT ADDRESS: 916 gakEs , v& P3 II ,r,// <br /> DESCRIPTION OF WORK: INSTALL(1) NEW PORTABLES LANDING/WELCOME RAMP.�j(ffIJ Elwin <br /> CONTACT INFORMATION: JJ <br /> OWNER: APPLICANT: <br /> NAME: EVERETT SCHOOL DIST 2 NAME: COLLINS J <br /> ADDRESS: 4730 COLBY AVE ADDRESS: <br /> EVERETT,WA, 98203 <br /> PHONE: PHONE: 4253854195 <br /> EMAIL: EMAIL: JCOLLINS@EVERETTSD.ORG <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?'YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: PAW/go'{—CB.G <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 /> IN O <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 3/4 Detect Meter Only, 0 Fire Service Size <br /> 1260 NO <br /> Explanation: 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 /> 4 NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> OYES—Amount$ 3 QSt, 24 KSee Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: 24 44 <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> OYES—Amount$ $.?,381.57 0 See Atta Ted Spreadsheet <br /> ❑ NO 4265311000SF x 8'96 SF&rtrarfu&e 'W1331•57 4 f Ff- ib`onTi-Af&Acly - Vcfrionhvy se4001 . <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> LI YES—TYPE 0 See Attached Letter <br /> IR NO <br /> PW Reviewer: I I / Date: <br /> RFVI.CFn 1n/11/2n1 <br />