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PUBLIC WORKS <br /> f REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/23/2016 <br /> Permit#: PW1608-044 <br /> PROJECT ADDRESS: 6406 HIGHLAND DR <br /> DESCRIPTION OF WORK: SITE DEVELOPMENT FOR NEW SFR DETACHED <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: TSYMBALYUK VOLODYMYR/LINA NAME: TSYMBALYUK VOLODYMYR/LINA <br /> ADDRESS: 505 103RD PL SE ADDRESS: 505 103RD PL SE <br /> EVERETT,WA, 98208 EVERETT,WA, 98208 <br /> PHONE: 4252931892 PHONE: 4252931892 <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: TSYMBALYUK VOLODYMYR/LINA <br /> PHONE: 4252931892 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?PSI YES 0 NO W.0.#: CA <br /> /� <br /> Notes: Associated Bldg./PW Permit#: C�6©8-OM <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> 0 YES–Type (If yes, add_,[to TRAKiT runder Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> EExxplaanation: 6tZ6 CODE /0144111 301 CJFh rlu <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System/ JDevelopment Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> . .YES–Amount$ 0 YES–Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0 3/" Detect Meter Only, 0 Fire Service Size <br /> XNO atoeft 2 NO <br /> Explanation .- .I_A( ...61.4.Nre,e, JAVE,, S' ( Explanation: <br /> ❑Water Department � t stm to Needed yes, 'W-eviewe'r'to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? od <br /> t7�� <br /> EYES–Amount$ , 0 New Connection, ❑Alteration/Repair, X Cap-o-./Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES–Amount$ py$. 0 See Attached Spreadsheet <br /> ❑ NO–No Change of Use/Other <br /> Aff <br /> Explanation: n AA) .s >7.001.5F>7.001.5F A MO) —�f -for e sr . in ti!2>;SZ-.5,e,,,,tGE -- 71e:2) iv.- <br /> (Note:Public orks Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ? <br /> ❑YES–Amount$ ❑,,j� See Attached Spreadsheet <br /> 211 NO CI< Ste, Le pal, �dl►� <br /> ADDRESS LETTER REQUIRED?_c (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> EYES–TYPE 'FR See Attached Letter <br /> ❑ NO <br /> Pç?trM lic Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />