Laserfiche WebLink
PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 1/5/2017 <br /> Permit#: PW1701-005 <br /> PROJECT ADDRESS: 2021 LEXINGTON AVE A B <br /> DESCRIPTION OF WORK: SITE WORK FOR CONSTRUCTING NEW DUPLEX <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: HAACK BROTHERS INC NAME: JACOBS RACHEL <br /> ADDRESS: 3922 87TH AVE NE ADDRESS: <br /> MARYSVILLE,WA, 98270 <br /> PHONE: 4253977360 PHONE: 4259034852 <br /> EMAIL: 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.0. #: <br /> Notes: Associated Bldg./PW Permit#: r- ; i .�_i1 n���-� <br /> C r 7�1-vc�`3 <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 /> �N O =�--7 <br /> Explanation: �- il(c-f- .h�/ ���bC� C (,�:''n.r�ks / CL���C� Lv�f�(.ci�/���� <br /> � <br /> (Note: Counter Staff to Create Utility Permit fo�any Water/Sewer/System Development Fees) <br /> WATER FEES? '__Ll:, .�J �.:n. ,�l -�'c�` I,f.��,� f� <br /> DOMESTIC SERVICE: G�) FIRE SERVICE: <br /> ,�YES-Amount$ �.s/4--� ��j �/ �, ❑ YES-Amount$ <br /> ❑ Meter Only, �Complete Service, Size 7� �L'j � ❑ 3/4' Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO �� � � ❑ NO <br /> Explanation: Explanation: <br /> ❑ RPBA Needed at premise?-(Plumbing permit for backflow 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? ��(� <br /> ,�YES-Amount$ ��-' ❑ New Connection, �Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO - • ' . <br /> Explanatiorr: C�Sii�c� ��'XiSfin� ,.�.�5 .�7(cf- (,�'<<� f7��� l��'/S/�dIS Z�r �it/J��x <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? �X iS f"ihJc Ili>,�3� � 5,�� G���� — <br /> �'YES-Amount$ .3 J l/ ❑ See Attached Spreadsheet ,L�c;�C�=JC -� � /Z� �7�7 -' <br /> ❑ NO-No Change of Use/Other L��f� -� � �%�/ <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Tra�c Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ,� YES-Amount$ ���DC1 ❑ See Attached Spreadsheet <br /> ❑ NO ,� ' <br /> f?,rd�sc���ro�-� ��%����K�- �riclC <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,�YES-TYPE 1���,�L4'X ❑ See Attached Letter <br /> ❑ N O � -� <br /> 7 � <br /> - ,crti-' ,C�%-�c�-c:C�- •..:� - /S - <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />