1110 BROADWAY 2020-01-21 - Laserfiche WebLink

PUBLIC WORKS REVIEW WORKSHEET (ATTACH 1 SITE PLAN FOR REVIEW) Date: 6/30/2016 Permit#: PW1606-050 PROJECT ADDRESS: 1110 BROADWAY DESCRIPTION OF WORK: SITE WORK FOR BLDG ADDITION AND RENOVATION CONTACT INFORMATION: OWNER: APPLICANT: NAME: WILLIAMS INVESTMENTS I LLC NAME: [AppName] ADDRESS: 1020 W CASINO RD ADDRESS: [AppAdd] EVERETT, WA, 98204 [AppCi], [AppSt], [AppZip] PHONE: PHONE: [AppPhone] EMAIL: EMAIL: [AppEmail] CONTACT: ❑ Owner ❑ Applicant ❑Other NAME: HOFIUS DOUG PHONE: 4252593161 EMAIL: COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: PW Permit Required?:WYES ❑ NO W.O.#: Notes: Associated Bldg./PW Permit#: FIRE SPRINKLER REQUIRED? (by Fire Department/Code) ❑ YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) ❑ NO Explanation: (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) WATER FEES? DOMESTIC SERVICE: FIRE SERVICE: ❑ YES—Amount$ �d YES—Amount$ ❑ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size �NO ❑ NO Explanation: Explanation: ❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) 19 Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) Existing Utility Permit#(if applicable): SEWER FEE? ❑YES—Amount$ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect NO xplanation: Existing Utility Permit# (if applicable): SYSTEM DEVELOPMENT FEE? VES—Amount$ ❑ See Attached Spreadsheet O—No Change of Use//Other Explanation: (Note:Public Works Reviewer to Add Traffic 41figation to P Permit(if applicable)) TRAFFIC MITIGATION FEE? ,YES—Amount$19 .3--,;-q ❑ See Attached Spreadsheet ❑ NO ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) YES—TYPE ❑ See Attached Letter NO Reviewer: Date: R VISED 10/11/2016