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477PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/12/2016 <br /> Permit#: B1604-019 <br /> PROJECT ADDRESS: 10415 EVERGREEN WAY <br /> DESCRIPTION OF WORK: TI, OFFICES ON 2ND FLOOR-DWAYNE LANES I G Par/ ) 11 <br /> CONTACT INFORMATION: nUll/] V(AA'CitA✓ <br /> OWNER: APPLICANT: JJ <br /> NAME: LANE PROPERTIES LLC NAME: [AppName] <br /> ADDRESS: 10515 EVERGREEN WAY ADDRESS: [AppAdd] <br /> EVERETT, WA, 98204 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: SHAWISH MANAL <br /> PHONE: 4252522153 <br /> EMAIL: MANAL@2812ARCHITECTURE.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? 0 YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br /> 'R( Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> *NO <br /> lei �. sii.�lv a I ( � frYh}1, � <br /> Explanation: <br /> (Note: Counter Staff to Create UtilityPermit for anyWater/Sewer/System Development �J <br /> Y P Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑YES—Amount$ 0 YES—Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0 %" Detect Meter Only, 0 Fire Service Size <br /> XNO NO <br /> Explanation: Explanation: <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 applicable): <br /> SEWER FEE? <br /> ❑ YES—Amount$ El New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> �NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES—Amount$ ❑ See Attached Spreadsheet <br /> Zi<NO—No Change of Use/Other <br /> Explanation: 0,4h'N`&c- CfiP CISF <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 /> o YES-TYPE ❑ See Attached Letter <br /> N O <br /> 1 <br /> 'n/frkg. <br /> t /f/ Zal <br /> .lic Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />