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• PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/7/2016 <br /> Permit#: C1604-007 <br /> PROJECT ADDRESS: 10127 21ST AVE W <br /> DESCRIPTION OF WORK: BUILD NEW SAUNA <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: KHANENKOIVAN NAME: OWNER <br /> ADDRESS: 10127 21ST AVE W ADDRESS: <br /> EVERETT, WA, 98204 , , <br /> PHONE: 2539512338 PHONE: <br /> EMAIL: INVANKHANENKO@YAHOO.COM 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 j.' _. , ;",�, "�,� � '"-�' •_ = � '':' . Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED? (bv Fire DepartmenUCode) <br /> ❑YES-Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: Ju'�; - -- jI „ � � _ �� ,� - � Y:�.' r�-. . <br /> ♦�.. i� ° �r'� .<-:.�i ✓i.� �'�1 ? /' '�� �Is:' ��' <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 ❑3/<" Detect Meter Only, ❑ Fire Service Size <br /> q rvo ci�rvo <br /> Explanation: Explanation: <br /> ❑Water Department Cost Estimate Needed-(Ifyes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> q YES-Amount$ ❑ New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> �I N O _ `' �� � • ,.� <br /> � <br /> -._ __ - _ a __ _. � �T�. � <br /> Explanation: '�# - E=� ` _ - .�� r -.Y .�<�.�r'� �'i s . _ _�� ,:�;-� �;�� �'- ,_ , . <br /> � .=`�!F —r 7"l.1[':.' � �( :J (�u .y'V'v� ' '(• •f ..b.���.,�. <br /> �s_.'s.c%i'u <br /> i"^:L-s r '. <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENTFEE? <br /> ❑ YES-Amount$ ❑ See Attached Spreadsheet <br /> [� NO-No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Tra�c Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑ YES-Amount$ ❑ See Attached Spreadsheet <br /> �1 N 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 /> q NO <br /> � �! � � � .�,; � " � ' ��..�. - <br /> 1°�� <br /> Public Works Reviewer SignatureV Date <br /> REVISED 2/24/2016 <br />