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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/15/2017 <br /> Permit#: PW1703-025 <br /> PROJECT ADDRESS: 4125 GRAND AVE <br /> DESCRIPTION OF WORK: NEW SFR DETACHED <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: HOPPER JAMES W NAME: SIGNATURE HOMES <br /> ADDRESS: 4019 170TH ST SW ADDRESS: 11920 29TH AVE SE <br /> LYNNWOOD,WA, 98037 EVERETT,WA, 98208 <br /> PHONE: PHONE: 4252440549 <br /> EMAIL: EMAIL: JOHN@SIGNATURE-HOMES.NET <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: JOHN MUSTACHE <br /> P H O N E: 4252440549 <br /> EMAIL: JOHN@SIGNATURE-HOMES.NET <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?�YES ❑ NO W.O. #: <br /> Notes: Associated Bldg./PW Permit#: ��7G/- L��� <br /> FIRE SPRINKLER REQUIRED? (by Fire DepartmenUCode) <br /> ❑YES-Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> �N O <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: v� FIRE SERVICE: <br /> f�YES-Amount$ 2 i / "" � � ❑YES-Amount$ <br /> ❑ Meter Only, Complete Service, Size� ❑ 3/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO �'NO <br /> Explanation: Explanation: <br /> ❑ RPBA Needed at premise?-(Plumbing permit forbackflow 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? G��7 <br /> �J�YES-Amount$ 7� J�New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENTFEE? � <br /> �YES-Amount$ �' 7 ❑ See Attached Spreadsheet � � 7(,� <br /> ❑ NO-No Change of Us /Other <br /> Explanation: <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 /> �'N� Sf=ic oi� �,c��s`,,;� DL�/-;-- /�C�z7< <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,�'YES-TYPE S' /- �C' ,�See Attached Letter <br /> ❑ NO <br /> ,���� ,-r� _:3-�:S� <br /> PW Reviewer: Date: <br /> T�.rrezc� � �dc/ Z`z� C�U� l3cK /c� �0T // =�Z <br /> REVISED 10/11/2016 <br />