5611 COLBY AVE 2017-04-19 - Laserfiche WebLink

Mlq PUBLIC WORKS �0 A REVIEW WORKSHEET 1 � (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/5/2016 Permit#: B1602-022 PROJECT ADDRESS: 5611 COLBY AVE DESCRIPTION OF WORK: CONSTRUCT PARTITION WALLS TO CREATE TWO BEDROOMS-AFH CONTACT INFORMATION: OWNER: APPLICANT: NAME: BALANGUE DEBORA L&ADAN NAME: [AppName] ADDRESS: 6802 CADY RD ADDRESS: [AppAdd] EVERETT,WA, 98203 [AppCi], [AppSt], [AppZip] PHONE: PHONE: [AppPhone] EMAIL: EMAIL: [AppEmail] CONTACT: ❑ Owner ❑ Applicant ❑Other NAME: MACTAL RON PHONE: 4257863247 EMAIL: RONMACTAL@YAHOO.COM COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: PW Permit Required? ❑ YES XNO W.O. #: Notes: ' Associated Bldg./PW Permit#: //�/f 6CO�`r eck7 GG�iC'�rcice:�6'j- /o phis eyplifl i Ali P�L> C /s// FIRE SPRINKLER REQUIRED? (by Fire Department/Code) ,oe-r, 4 i.,1'e ❑ 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 FEE? ❑YES—Amount$ ❑ Meter Only, ❑ Complete Service, Type/Size ❑ NO Explanation: Existing Utility Permit#(if applicable): SEWER FEE? ❑YES—Amount$ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect ❑ NO Explanation: Existing Utility Permit#(if applicable): SYSTEM DEVELOPMENT FEE? ❑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 ❑ 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 Public Works Reviewer Signature Date REVISED 1/5/2016