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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 'C=W'G ;�)L'CJ <br /> DESCRIPTION OF WORK: NEW SFR-BASIC R131 502-002 PLAN#1831 <br /> �6�3 � ole <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 /> %NO <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: �•L FIRE SERVICE: <br /> OYES—Amount$ 2�S1 ❑YES—Amount$ <br /> ❑ Meter Only, ❑ Complete Service, Size_ ❑ %" Detect Meter Only, ❑ Fire Service Size <br /> 0N 0N <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 /> MMES—Amount$�f ) New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? KJ <br /> bNES—Amount$���2. '— See Attached Spreadsheet <br /> O—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$ ❑ See Attached Spreadsheet <br /> NNO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE ❑ See Attached Letter <br /> ❑ NO <br /> PuU% s evlewer Signature Date <br /> REVISED 2/24/2016 <br />