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PUBLIC WORKS <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) <br />PROJECT ADDRESS: 615 80TH ST SW <br />DESCRIPTION OF WORK: SITE WORK FOR BLDG ADDITION <br />CONTACT INFORMATION: <br />OWNER: APPLICANT: <br />NAME: TYTUS WILLIAM B & SUSAN B NAME: <br />ADDRESS: 615 80TH ST SW ADDRESS <br />EVERETT, WA, <br />PHONE: PHONE: <br />EMAIL: EMAIL: <br />CONTACT: <br />NAME: <br />PHONE <br />EMAIL: <br />❑ Owner ❑ Applicant ❑Other. <br />NELSON NED <br />4254446782 <br />n.com <br />COMMENTS FROM PUBLIC WORKS REVIEWER: <br />PW Permit Required? 11 YES ❑ NO 2 <br />Notes: S`� fw e& A /fit oy AnA. <br />Date: 12/29/2016 <br />Permit #: PW1612-044 <br />[AppName] <br />[AppAdd] <br />[AppCi], [AppSt], [AppZip] <br />[AppPhone] <br />[AppEmail] <br />Xff L, I19X1M="3*a1=M <br />W.O. M <br />Associated Bldg./PW Permit #: <br />FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br />❑ YES —Type ,�,Af (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br />NO <br />❑xplaanation: , /ri J� <br />E►>l VAL lhp f?rp-, 1eE� <br />(Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br />WATER FEES? <br />DOMESTIC SERVICE: ,FIRE SERVICE: <br />❑ IaI YES — Amount $ YES — Amount $ / i► <br />❑ Meter Only, ❑ Complete Service, Size td %" Detect Meters IQ Fire Service Size O <br />Id NO ❑ NO <br />Explanation: Explanation: 0G2 &IttA elf'A' L�OS� ��Tllitaft� �£ <br />❑ RPBA Needed at premise? -(Plumbing permit for backflow device needed due to High -Hazard Site per Tim Markham's review) <br />� <br />14 Water Department Cost Estimate Needed -(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) $a <br />Existing Utility Permit # (if applicable): <br />SEWER FEE? <br />❑ YES — Amount $ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br />% NO <br />Explanation: <br />Existing Utility Permit # (if applicable): <br />SYSTEM DEVELOPMENT FEE? <br />❑ YES — Amount $ ❑ See Attached Spreadsheet <br />14 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 $ ❑ See Attached Spreadsheet <br />04 NO <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />❑ YES — TYPE ❑ See Attached Letter <br />If NO <br />PW Reviewer: A <br />—a&� <br />Date: 2� 1 � I ann- <br />REVISED 10/1112016 <br />