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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/22/2016 <br /> Permit#: PW1607-040 <br /> PROJECT ADDRESS: 6605 HIGHLAND DR <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR(LOT 3) <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: JACOBS DUANE NAME: BUSTARD CUSTOM CONST INC <br /> ADDRESS: 6601 HIGHLAND DR ADDRESS: PO BOX 1243 <br /> EVERETT, WA, 98203 MARYSVILLE,WA, 98270 <br /> PHONE: PHONE: 4258766551 <br /> EMAIL: EMAIL: amkhomes@gmail.com <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: BUSTARDPAUL <br /> PHON E: 4258766551 <br /> EMAIL: amkhomes@gmail.com <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: �S I�� O60 <br /> PW Permit Required?�YES ❑ NO W.O.#:_ �'a� � '�`o���_V—DO$ <br /> Notes: Associated BIdg.IPW Permit#: �0�����Q� <br /> FIRE SPRINKLER REQUIRED? (bv Fire DepartmenUCode) <br /> ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> 1�N O Q <br /> Explanation: -� � <br /> (Note: Counter Staff to Create Utility Permit for any Water/ ewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑ YES—Amount$ ❑YES—Amount$ <br /> ❑ Meter Only, ❑ Complete Service, Size ❑ 3/4' Detect Meter Only, ❑ Fire Service Size <br /> �plaOnation: ��5� � S�� D�� � `U �sd�-��� �plO ation: <br /> ❑Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> �YES—Amount$ �'�,� �New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit# (if applicable): S Sh >S � <br /> SYSTEM DEVELOPMENT FEE? ����f�� ��'\ <br /> �(YES—Amount$ � ❑ See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation:_�Q� ��, �a3°l`����,�IU .�' <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 /> �"° P� �� s �- �c �s��-oo� � P�460�4-02� <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> �YES—TYPE I�See Attached Letter <br /> ❑ NO <br /> J / <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />