5208 BEVERLY LN 2018-04-03 - Laserfiche WebLink

PUBLIC WORKS REVIEW WORKSHEET (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/5/2016 Permit#: B1604-008 PROJECT ADDRESS: 5208 BEVERLY LN DESCRIPTION OF WORK: NEW RESIDENTIAL WORKSHOP CONTACT INFORMATION: /604 p0` 3 OWNER: APPLICANT: NAME: ERICKSON JERRY NAME: [AppName] ADDRESS: 5208 BEVERLY LN ADDRESS: [AppAdd] EVERETT,WA,98203-3146 [AppCi],•[AppSt], [AppZip] PHONE: PHONE: [AppPhone] EMAIL: EMAIL: [AppEmail] CONTACT: 0 Owner 0 Applicant ❑Other • NAME: [ContactName] PHONE: [ContactPhone] EMAIL: [ContactEmail] COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: PW Permit Required?' YES 0 NO W.O.#: Notes: Associated Bldg./PW Permit#: FIRE SPRINKLER REQUIRED?(by Fire Department/Code) ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) ANO Explanation: (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) WATER FEES? DOMESTIC SERVICE: FIRE SERVICE: ❑YES—Amount$ 0 YES—Amount$ 0 Meter Only, 0 Complete Service, Size ❑%" Detect Meter Only, 0 Fire Service Size -71.NO ❑ NO Explanation: Explanation: ❑Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) Existing Utility Permit#(if applicable): SEWER FEE? ❑YES—Amount$ 0 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect )200 Explanation: Existing Utility Permit#(if applicable): SYSTEM DEVELOPMENT FEE? ❑YES—Amount$ 0 See Attached Spreadsheet NO—No Change of Use/Other Explanation: (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) TRAFFIC MITIGATION FEE? ❑YES—Amount$ 0 See Attached Spreadsheet *NO ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) ❑YES—TYPE 0 See Attached Letter ANO Public Works ReviewerSignature Date REVISED 2/24/2016