Laserfiche WebLink
Auk <br /> PUBLIC WORKS qW <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 5118/2016 <br /> Permit M C1605-015 <br /> PROJECT ADDRESS: 15 FERN RD <br /> DESCRIPTION OF WORK: NEW DUPLEX WITH ATTACHED GARAGES <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: HENDERSON PHILIP L&MARIANNE NAME: [AppName] <br /> ADDRESS: 15 FERN RD ADDRESS: [AppAdd] <br /> EVERETT,WA,98203 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: HAACK JOEL <br /> PHONE: 4252902429t-- <br /> EMAIL: JOEL@HAACKBROTHERS.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT M <br /> PW Permit Required?X YES ❑ NO W.O.M / <br /> Notes: Associated Bldg./PW Permit#: T p W 16055—0ZQ <br /> FI E SPRINKLER REQUIRED?(by Fire Department/Code) <br /> YES-Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> JO C� <br /> explanation:Ela - <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: t76 FIRE SERVICE: <br /> AYES-Amount$ Z� ,r ❑ YES-Amount$ <br /> R Meter Only, 1R c plete Service, Size 3(y ❑%" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO I ONO <br /> Explanation: Ul (f 3 y rl 0,&m Sir Explanation: <br /> n i g r i �l9 ' m trp :wQ F_ - 'FlQd--1-v iue-f�c Ce rc we f Uva rU C., <br /> IR❑Water Departmenf Cosf�stimate eeded-(ff yes; PW Reviewer to send cost estimate request to W ter Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> I'YES-Amount$ h�,� ❑ New Connection, ❑Alteration/Repair, g Cap-offeconnect <br /> ❑ NO <br /> Explanation: f)nlf" ll-� 9 •-fr' i r C,E71lE� �f ZJ F-K S* S'E'lGUeif <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> V YES-Amount$ ❑ See Attached Spreadsheet <br /> ❑ NO-No Change of Use/Other <br /> Explanation: NEW 111,2i t/x (,55� ��x SFie (� �Z 3F 'C 'c - �l$��• NST Di�E. <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> YES-Amount$ 9A 00. ❑ See Attached Spreadsheet <br /> ❑ NOx�$y8L 3FK 0<cD(T(rZy0�) :;; -�ZYM METC)le <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br /> Et YES-TYPE �(See Attached Letter <br /> ❑ NO <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />