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OrEn- PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/2/2016 <br /> Permit#: C1602-002 <br /> PROJECT ADDRESS: 5622 LOWELL RD <br /> DESCRIPTION OF WORK: ADD BATHROOM &CLOSET TO MASTER BEDROOM <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: ADKINS ALAN & MOORE MELODY NAME: OWNER <br /> ADDRESS: 5622 LOWELL RD ADDRESS: <br /> EVERETT, WA, 98203 <br /> PHONE: 4254453615 PHONE: <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant DOther <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? 0 YESCarl O W.O.#: <br /> Notes: Associated Bldg./PW Per'mit#: <br /> QIA) not 1(7-jellf&r, A D> 8i�7 NIS com aci <br /> i`- <br /> FIRE SPRINKLER REQUIRED? (by Fire Department/Cod) <br /> ❑ YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> O <br /> xplanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEE? <br /> ❑ YES—Amount$ 0 Meter Only, 0 Complete Service,Type/Size <br /> zE(N O <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> ❑ ES—Amount$ 0 New Connection, 0 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 /> 2dNO—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 /> ❑ Y,ES—Amount$ 0 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 0 See Attached Letter <br /> yN O <br /> }dg )01441 MI6 <br /> blic Works Reviewer Signature Da e <br /> REVISED 1/5/2016 <br />