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���Ct,t2 5 �h �� ' � �Q�c�e� <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/25/2016 <br /> Permit#: C1603-067 <br /> PROJECT ADDRESS: 4404 FOREST DR LOT 3 <br /> DESCRIPTION OF WORK: NEW SFR RB1603-001 - PLAN 2309-2 � <br /> ����_ � ����� _ ���->' <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POHLAND TODD NAME: [AppName] <br /> ADDRESS: 314 HEATHER RD ADDRESS: [AppAdd] <br /> EVERETT,WA, 98203 [AppCi], [AppSt], [AppZip] <br /> PHONE: 4253459003 PHONE: [AppPhone] <br /> EMAIL: toddpohland@gmail.com EMAIL: [AppEmail] <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: POHLAND TODD <br /> PHONE: 4253459003 <br /> EMAIL: toddpohland a�gmail.com <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? � YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED? (bv Fire Department/Code) <br /> 1�YES—Type i�� (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: FIRE SERVICE: <br /> ❑YES—Amount$ ���� s� ❑YES—Amount$ <br /> � Meter Only, ❑ Complete Service, Size � ❑3/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO ❑ NO <br /> Explanation: Explanation: <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? �:C; <br /> ,� YES—Amount$ �l � ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENTFEE? <br /> �YES—Amount$ ❑ See Attached Spreadsheet - <br /> ❑ NO—No Change of Use/Other �r=' S�Z� C�a ,�PN <br /> Explanation: L'�T� � S�• � ,o /7� �%l�bCO� <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 LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,�YES—TYPE S'r-=� �See Attached Letter <br /> ❑ NO <br /> �._��:' ,���� ��--- � - �-� � <br /> Public Works Reviewer�gnature Date <br /> REVISED 2/24/2016 <br />