5506 GLENWOOD AVE 2017-06-28 - Laserfiche WebLink

PUBLIC WORKS REVIEW WORKSHEET � (ATTACH 1 SITE PLAN FOR REVIEW) Date: 1017/2015 Permit#: PW1510-012 PROJECT ADDRESS: 5506 GLENWOOD AVE � DESCRIPTION OF WORK: PW FOR NEW SFR CONTACT INFORMATION: OWNER: APPLICANT: NAME: LITOVCHENKO ALEX NAME: OWNER ADDRESS: 4933 GLENWOOD AVE ADDRESS: EVERETT, WA, 98203-1636 , , PHONE: 4253441875 PHONE: EMAIL: EMAIL: CONTACT: � Owner ❑ Applicant ❑Other � NAME: [ContactName] PHONE: [ContactPhone] EMAIL: [ContactEmail] COMMENTS FROM PUBLIC WORKS REVIEWER: PW Permit Required? � YES ❑ NO LAND USE PROJECT#: Please provide explanation: � W.O. #: � �\��c� ��,,r �� Associated Bldg./PW Permit#: ., « FIRE SPRINKLER REQUIRED?�by Fire Department/Code ❑ YES-Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) Iffi N O 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: �X"i 57`i�� cJ�rfc�� S'�r v;C� C�>� Lioc-�.SE f��f /S v'e-�o�;��;c� Existing Utility Permit#(if applicable): SEWER FEE? ❑ YES-Amount$ ❑ New Connection, ❑ Alteration/Repair, j�Cap-o Reco�nnec NO /� / ��.;��/ xplanation: �C.X�Sfi�r� S^r v�Cr Tu U� ��'�r?�Z�C��, Existing Utility Permit# (if applicable): __ SYSTEM DEVELOPMENT FEE? S'�c�� "� rGvio�'_S ��C'G�S�E YES-Amount$ / ❑ See Attached S�readsheet �n �'�� ,� � 9`�� NO- No Change of Use 1 Other � __�v�.v�; /V��w f7ovs�- � �74 S � Explanation: � ��C- � ��Z - � / /4g (Note: Public Works Reviewer to Add Tra(fic Mitigation to PW Permit(if applicable)) TRAFFIC MITIGATION FEE? ❑ YES-Amount$ _ ❑ See Attached Spreadsheet � No �J/��F � ij�� / - -�-�-/C� Public Works Reviewer Signature Date ---------------- -- REVISED 12/16/2015