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41, <br /> PUBLIC WORKS • <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 11/22/2017 <br /> Permit#: PW1711-029 <br /> PROJECT ADDRESS: 10611 EVERGREEN WAY <br /> DESCRIPTION OF WORK: SITE WORK FOR ADDITIONS TO SHOWROOM&SERVICE BAY <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: S R KLEIN FISH-ON INVESTMENTS LLC NAME: [AppName] <br /> ADDRESS: PO BOX 3830 ADDRESS: [AppAdd] <br /> EVERETT,WA,98213 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: 0 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? tYES 0 NO W.O.#: { / <br /> Notes: ptu f311`©2 QQ 1 Associated Bldg./PW Permit#: gj!W/-Q?J5" <br /> .// 1 DOJ5—Of5 <br /> FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br /> ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: , tzfic/ A.0 <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development 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 /> Iii:0N O 'N O <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-Of yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): LP nn <br /> X of (SE't rE0 jEFAMnC `) <br /> SEWER FEE? I <br /> ❑YES—Amount$ ❑ New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> KNO <br /> Explanation: q <br /> Ex tint U ity Pe mi #(if applicable): , 11 1 0 '02/0 <br /> SYSTE DEVELO �,��- Gh 1 <br /> RYES—Amoun clog.YO ) "S'ee Attached Spreadsheets- y Wt1,Jsvivt- Will f1 "�-E4' d5 <br /> ❑ NO—No Chan r <br /> Explanation: &ill/ dd81171:Sint7 Mtn 0 rf0sr) )S'eRVICE MYS4/'/Os' ) <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? 00 On dd�la79 �,," � <br /> V YES—Amount$ 3�) ( IO." pee Attached Sf�u^-'l P9 ' / C�• <br /> 0 NO 404 40 t ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Le -r from TRAKiT Print Menu and include) <br /> ❑YES—TYPE 0 See Attached Letter <br /> 12r,NO sun& actamss -6- ►, ote, d-f., , <br /> PW Reviewer: jojtalft Date: <br /> LicA,,�r lil !g <br /> REVISED 10/11/2016 <br />