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r <br /> PUBLIC WORKS I , ccq <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 1/7/2016 <br /> Permit#: PW1601-005 <br /> PROJECT ADDRESS: 1627 RUCKER AVE SE <br /> DESCRIPTION OF WORK: NEW ADDITION & DECK <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: MARDESICH ANGELA NAME: NW QUALITY REMODEL& DECK LLC <br /> ADDRESS: 1627 RUCKER AVE ADDRESS: 15414 91ST AVE SE <br /> EVERETT,WA, 98201 SNOHOMISH, WA, 98290 <br /> PHONE: 3606680191 PHONE: 3606680191 <br /> EMAIL: EMAIL: <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: WILLEY TERRY <br /> PHONE: 4254224759 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? ❑ YES XNO 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 FEE? <br /> ❑YES—Amount$ ❑ Meter Only, ❑ Complete Service,Type/Size <br /> ❑ NO <br /> Explanation: <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): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES—Amount$ ❑ See 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 /> ❑ YES—Amount$ ❑ See Attached Spreadsheet <br /> ❑ NO <br /> ADDRESS LETTIfk REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑ YES—TYP ❑ See Attached Letter <br /> ❑ NO e <br /> u lic Wrks Reviewer Signa re Date <br /> REVISED /5/2016 <br />