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14677. PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/2/2016 <br /> Permit#: PW1603-007 <br /> PROJECT ADDRESS: 4634 ALGER AVE <br /> DESCRIPTION OF WORK: TRENCHING AND GROUND BASED EQUIPMENT FOR VERIZON ANTENNAE <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: ZION LUTHERAN CHURCH-EVER NAME: [AppName] <br /> ADDRESS: PO BOX 2116 ADDRESS: [AppAdd] <br /> EVERETT,WA, 98213 [AppCi], [AppSt], [AppZip] <br /> PHONE: 4252521429 PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <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#: <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 /> ANO <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" Deduct Meter Only, 0 Fire Service Size <br /> PS,NO ❑ NO <br /> Explanation: Explanation: <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, ❑ Alteration/Repair, 0 Cap-off/Reconnect <br /> O <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> P!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$ 0 See Attached Spreadsheet <br /> YN O <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE 0 See Attached Letter <br /> XN O ' <br /> ,L, e� 16 <br /> Pu:� . s Reviewer Signature D to <br /> REVISED 2/24/016 <br />