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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/26/2016 <br /> Permit#: PW1607-04 <br /> PROJECT ADDRESS: 2015 79TH ST SE Azpll-)G) ///_5 <br /> DESCRIPTION OF WORK: CONSTRUCT NEW TOWNHOUSE UNIT <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: ALPINE HEIGHTS DEVELOPMENT NAME: STEVE SNYDER <br /> ADDRESS: 120 SW EVERETT MALL WAY ST100 ADDRESS: 120 SW EVERETT MALL WAY <br /> EVERETT, WA, 98204 EVERETT,WA, 98204 <br /> PHONE: PHONE: <br /> EMAIL: EMAIL: MATTR@SEAPACHOMES.COM <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?RYES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br /> kYES—Type /3 D (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: fe, .Ile, <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: t7 FIRE SERVICE: <br /> ❑ YES—Amount$ ❑YES—Amount$ <br /> ,Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO ❑ NO <br /> Explanation: Explanation: <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? DU <br /> YES—Amount$ 7� , New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> KYES—Amount$ ❑ See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other 17 -7-5- <br /> Explanation: 77-5- <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ 0 ❑ See Attached Spreadsheet <br /> XNO D,q l'd 1,-r6&1/,?CQ f 1W4kr /--CC'0r01C CY1 <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> OYES—TYPE _5/ciZ ❑ See Attached Letter <br /> ❑ NO 7 // <br /> " <br /> l71� 7-Z6 Ja <br /> Public Works Reviewer Signature Date <br /> REVISED 2124/2016 <br />