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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 6/21/2016 <br /> Permit#: PW1606-037 <br /> PROJECT ADDRESS: 1208 100TH ST SW <br /> DESCRIPTION OF WORK: NEW SFR WITH 4 CAR ATTACHED GARAGE <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: HAACK BROS CONST INC NAME: HAACK JOEL <br /> ADDRESS: 3922 87TH AVE NE ADDRESS: <br /> MARYSVILLE,WA, 98270 <br /> PHONE: 4253977360 PHONE: 4252902429 <br /> EMAIL: EMAIL: <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? ❑ YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER R ED? b Fire De artment/Cc�'^` _ <br /> ❑YES—Type (If yes, adc; ,,, ��.��.�� ,.,�,.�� ..�„����c� �omments on Bldg Permit and Stamp Drawings) <br /> ,,�N O /��� � <br /> Explanation: �C'V'i�c��ti/ T/v'� ���G �"S'L�-`� 5��� n��c' bz�LC��c;� <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$ ❑YES—Amount$ <br /> ❑ Meter Only, ❑ Complete Service, Size ❑'/<" Detect Meter Only, ❑ Fire Service Size <br /> �NO ° / /� � ❑ NO <br /> Explanation: _ �,�/.S'C/r'1C WQ'7�✓� �/�'1/'i'G� Explanation: <br /> �Water Department Cost Est�iJ1'1 atQ Needed-(If yes, PW Revieyver to sen�cost estir}�ate req�iest to Water Department, attach r,opy) <br /> .�'av�.�� St_G ctllGChc.Q� GZ��G;�Q„�' Cv;LL�jtti/'�'Z730 �of" �'i�;.' ,Ei/ � <br /> Existing Utility Permit#(if applicable): � <br /> SEWER FEE? <br /> ❑YES—Amount$ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> �`NO . -/ / / /_ �"� <br /> Explanation: �'/�dl�i�7�C�0 S�.Ge.�e'.!i' V/S7�"/Cff— �'-]ET !��"'<y1!¢S fY/2Y'� �Gf Y'e.'�✓��Y <br /> _�--� <br /> Existing Utility Permit#(if applicable): ,�. ,��f�q, <br /> SYSTEM DEVELOPMENT FEE? �X�St/�� r`3�� � �9�� <br /> J��YES—Amount$ 7Y�/ ❑ See Attached Spreadsheet �`�'�'/`-����� zrP� `� , .� <br /> ❑ NO—No Change of Use/Other � 7 � C✓Uf' <br /> Explanation: �/��Q��(� !h }�i^��CS;�� ��S�js�,p' �0�� .S/Zr.. <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 ��,� �See Attached Letter <br /> ❑ NO <br /> �� � ��4 �/(� <br /> Public Works Reviewer Signature Date <br /> REVI SED Z24/2016 <br />