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4477 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 12/1/2016 <br /> Permit#: PW1612-005 <br /> PROJECT ADDRESS: 79/2 20TH AVE SE Loi 44 <br /> DESCRIPTION OF WORK: CONSTRUCT NEW TOWNHOUSE UNIT/SITE WORK <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: ALPINE HEIGHTS DEVELOPMENT NAME: STEVE SNYDER <br /> ADDRESS: 120 SW EVERETT MALL WAY ST100 ADDRESS: 120 SW EVERETT MALL WAY <br /> EVERETT,WA,98204 EVERETT,WA,98204 <br /> PHONE: PHONE: <br /> EMAIL: EMAIL: MATTR@SEAPACHOMES.COM <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: jContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?El YES 0 NO W.O.#: <br /> Notes: Associated BIdg.IPW Permit#: 67606---©6v¢ <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ,AYES–Type L3 v (If yes, add to TRAKIT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: ! p FIRE SERVICE: <br /> 0 YES–Amount$ 5–�O ❑YES–Amount$ <br /> Meter Only, ❑ Complete Service, Size //� ❑'/"Detect Meter Only, 0 Fire Service Size <br /> 0 N 0 N <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-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> –7,00 <br /> X'YES–Amount$ — K New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> D YES–Amount$_ 7%2 0 See Attached Spreadsheet /616° <br /> ❑ NO–No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES–Amount$ O DO 0 See Attached Spreadsheet <br /> X NO Pa ill r:•Mer pLr- CAMS recorded <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKIT Print Menu and include) <br /> $1 YES–TYPE S/_I .See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> 47:ezan...A.„ /2^ / --/ <br /> REVISED 10/11/2016 <br />