11702 25TH AVE SE 2017-01-13 - Laserfiche WebLink

PUBLIC WORKS REVIEW WORKSHEET (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/1/2016 Permit#: C1604-002 PROJECT ADDRESS: 11702 25TH AVE SE DESCRIPTION OF WORK: SFR ADDITION CONTACT INFORMATION: OWNER: APPLICANT: NAME: CATON RYAN &SAFREENA NAME: [AppName] ADDRESS: 11702 25TH AVE SE ADDRESS: [AppAdd] EVERETT,WA, 98208 [AppCi], [AppSt], [AppZip] PHONE: PHONE: [AppPhone] EMAIL: EMAIL: [AppEmail] CONTACT: ❑ Owner ❑ Applicant ❑Other NAME: [ContactName] PHONE: [ContactPhone] EMAIL: [ContactEmail] COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: ' PW Permit Required? ❑ YES Q NO W.O. #: - . •: �.. Notes __ � �'��°'`�" �'�• ° ' ° "F�� - °°" � ' Associated Bldg./PW Permit#: . .� . 'e ^�° -o FIRE SPRINKLER REQUIRED? (bv Fire DepartmenUCode) ❑ YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) �NO Explanation: (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) WATER FEES? DOMEST/C SERV/CE: FIRE SERV/CE: ❑ YES—Amount$ ❑YES—Amount$ ❑ Meter Only, ❑ Complete Service, Size ❑ 3/<" Detect Meter Only, ❑ Fire Service Size �Fa NO �NO Explanation: Explanation: ❑Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) Existing Utility Permit#(if applicable): SEWER FEE? ❑YES—Amount$ ❑ New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect '�N O Explanation: Existing Utility Permit#(if applicable): SYSTEM DEVELOPMENTFEE? ❑ YES—Amount$ ❑ See Attached Spreadsheet �NO—No Change of Use/Other Explanation: (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) TRAFFIC MITIGATION FEE? ❑YES—Amount$ ❑ See Attached Spreadsheet I�NO ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) ❑YES—TYPE ❑ See Attached Letter �NO ��./�! ��r�- � '��' _ ..� . _- � . .�, - � Public Works Reviewer Signature Date REVISED 2/24/2016