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0 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/8/2016 <br /> Permit#: C1603-004 <br /> PROJECT ADDRESS: 1818 CHESTNUT ST <br /> DESCRIPTION OF WORK: NEW SFR- BASIC RB1502-002 PLAN#1831 <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: HAACK BROTHERS INC NAME: [AppName] <br /> ADDRESS: 3922 87TH AVE NE ADDRESS: [AppAdd] <br /> MARYSVILLE, WA, 98270 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?OYES ❑ 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 /> tKNO <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: �.0 FIRE SERVICE: <br /> OYES—Amount$ Z S�� ❑YES—Amount$ <br /> ❑ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size <br /> ❑ 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? )e <br /> AYES—Amount$ 01 New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? ,-f <br /> Ts&ES—Amount$���Z ''— C)CSee Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> KYES—Amount$ ❑ 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 /> ❑ YES—TYPE ❑ See Attached Letter <br /> ❑ NO <br /> / 1:-20 <br /> P�u s evlewer Signature Date <br /> REVISED 2/24/2016 <br />