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477 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 11/1/2017 <br /> Permit#: PW1711-003 <br /> PROJECT ADDRESS: 3317 RUCKER AVE Units C & D B1712-005 <br /> DESCRIPTION OF WORK: SITE WORK DEMO HOUSE/REPLACE WITH 2 DUPLEXES <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: 3317 RUCKER AVE LLC NAME: [AppName] <br /> ADDRESS: 16511 41ST PL W ADDRESS: [AppAdd] <br /> LYNNWOOD,WA, 98037 [AppCil, [AppSt], [AppZip] <br /> PHONE: 2062883701 PHONE: [AppPhone] <br /> EMAIL: ADNAN.ALI985@GMAIL.COM EMAIL: [AppEmail] <br /> CONTACT: ErOwner 0 Applicant ❑Other <br /> NAME: BRAD RZECHULA <br /> PHONE: 4258700350 <br /> EMAIL: BRADRZECHULA@GMAIL.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? ['YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: (1)1 O0 5- <br /> 1,/ FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> IES-Type 13 p (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> 0 NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utili y Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? t/t '(gO -005 <br /> DOMESTIC SERVICE: ° Gv FIRE SERVICE: <br /> l; 'ES-Amount$ 30i(p ,� 0 YES-Amount$ <br /> 0 Meter Only, 13110romplete Service, Size 1 0 3/4" Detect Meter Only, 0 Fire ServiceeSize <br /> NO <br /> ❑xplaanation: Explanation:E1Uh <br /> laanation: t3� atr i.„VDmCftb1 <br /> ❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazardit�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? a C 0 <br /> lia'S'ES-Amount$ 70 cew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SY§TEM DEVELOPMENT FEE? <br /> @'YES-Amount$ 4341y° N(See Attached Spreadsheet <br /> ❑ NO-No Change of Use/Other / <br /> Explanation: feebovG (eFic/ S 6r&i�; -AV 63tiS ' F12- -��IrIVC,wt's 960.64 <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> ,,(Note: <br /> MITIGATION FEE? <br /> leYES-Amount$ 2.4c 0 See Attached Spreadsheet CGpeciit Qi Y(pt <br /> f �E <br /> ❑ NO 4, MLs Dewed) <br /> 'ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> IeES-TYPE &lee Attached Letter <br /> 0N <br /> PW Reviewer: Date: <br /> ' t (6 gi <br /> REVISED 10/11/2016 <br />