2124 LEXINGTON AVE 2017-06-13 - Laserfiche WebLink

PUBLIC WORKS REVIEW WORKSHEET (ATTACH 1 SITE PLAN FOR REVIEW) Date: 5/24/2016 Permit#: PW1605-028 PROJECT ADDRESS: 2124 LEXINGTON AVE f 1605 -613 DESCRIPTION OF WORK: NEW SFR CONTACT INFORMATION: OWNER: APPLICANT: NAME: RVHARDT PROPERTIES LLC NAME: HAACK BROS CONST INC ADDRESS: 7714 78TH PL NE ADDRESS: 3922 87TH AVE NE MARYSVILLE,WA, 98270 MARYSVILLE,WA, 98270 PHONE: PHONE: 4253977360 EMAIL: EMAIL: CONTACT: ❑ Owner ❑ Applicant ❑Other NAME: HAACK BROS CONST INC PHONE: 4253977360 EMAIL: COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: PW Permit Required?P(YES ❑ NO W.O.#: 1202--Za/s —o07 Notes: Associated Bldg./PW Permit#: C ��G'S-01--3 FIRE SPRINKLER REQUIRED?(by Fire Department/Code) ❑ 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 FEES? DOMESTIC SERVICE: FIRE SERVICE: ❑YES—Amount$ ❑YES—Amount$ ❑ Meter Only, ❑ Complete Service, Size ❑3/d' Detect Meter Only, ❑ Fire Service Size NO Fec: J�CYic�GLr^e 4�/ �///aG��G Oplanation: Explanation: ❑Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost(estimate request to Water Department, attach copy) Existing Utility Permit#(if applicable): SEWER FEE? oe , YES—Amount$ ❑ New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect ❑ NO Explanation: Existing Utility Permit#(if applicable): SYSTEM DEVELOPMENT FEE? 9y9 /7GCiSY CC,— A YES—Amount$_ 7!!f4,2_ ❑ See Attached Spreadsheet / ❑ NO—No Change of Use/Other Explanation: (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) TRAFFIC MITIGATION FEE? ❑YES—Amount$ ❑ See Attached Spreadsheet )R'NO p-611,; - or�P��f ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) YES—TYPE S u=. See Attached Letter _9NO Public Works Reviewer Signature Date REVISED 2/24/2016