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47' PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 6/21/2016 <br /> Permit#: PW1606-036 <br /> PROJECT ADDRESS: 921 WALL ST <br /> DESCRIPTION OF WORK: NEW PAVING PAD ONSITE FOR INFILL DWELLING UNIT <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: WILLIAMS APRIL NAME: [AppName] <br /> ADDRESS: 921 WALL ST ADDRESS: [AppAdd] <br /> EVERETT, WA, 98201-3933 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: WILLIAMS APRIL <br /> PHONE: 4253284938 <br /> EMAIL: ASILVERW@HOTMAIL.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?tiYES 0 NO ,,/� , W.O.#: <br /> Notes: Pw p€/Z4n �. l �� i35' a/ Ei t{ Associated Bldg./PW Permit#: 406-041- <br /> .276 <br /> Qy-of h/dg p 2 # iWS//. <br /> FIRE SPRINKLER REQUIRED? (by Fire'6epartment/Code) <br /> 0 YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> NO <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 /> 0 YES—Amount$ 0 YES—Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0 3/4" Detect Meter Only, 0 Fire Service Size <br /> 'NO tirNO <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$ 0 New Connection, ❑Alteration/Repair, 0 Cap-off/Reconnect <br /> XN O <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> YES—Amount$ 0 See Attached Spreadsheet <br /> ❑ 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 /> XNO <br /> 1 ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> • 0 YES—TYPE ❑ See Attached Letter <br /> ❑ NO <br /> 4/3-0/2-et( <br /> Public Works Reviewer Signature D <br /> REVISED 2/24/2016 <br />