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AMIL <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/26/2016 <br /> Permit#: B1610-035 <br /> PROJECT ADDRESS: 10415 10TH DR SE <br /> DESCRIPTION OF WORK: ADD STUDY TO MASTER BEDROOM,ADD DECK TO EXTG DECK <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: HAMMERICKSEN GEORGE R NAME: [AppName] <br /> ADDRESS: 10415 10TH DR SE ADDRESS: [AppAdd] <br /> EVERETT, WA, 98208-4719 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: MORRISON TED <br /> PHONE: 4255125749 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? ❑ YES ,KNO 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 /> )WNO <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$ ❑YES—Amount$ <br /> ❑ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size <br /> XNO ❑ NO <br /> Explanation: Explanation: <br /> ❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> ❑Water Department Cost Estimate Needed-(/f 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 /> 'R-NO <br /> Explanation: <br /> Existing Utility Permit# (if applicable): <br /> SYSTEM DEVELOPMENT FEE? CJ$ <br /> ❑YES—Amount$ ❑ See Attached Spreadsheet !� Pr— P�SE� <br /> (NO—No Change of Use/Other 1 <br /> Explanation: L a C'!Y� Sf Zx -�+ /N! �C�'.tc��� ��/� � T G r <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 /> ,WN O <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 /> �(N O <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />