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4EnrPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 12/11/2017 <br /> Permit#: C1712-008 <br /> PROJECT ADDRESS: 6007 ROCKEFELLER AVE SE <br /> DESCRIPTION OF WORK: ADULT FAM HOME CONVERSION -MODIFY EXISTING BATHROOM TO MEET <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: MALCHEREK DANIELLE E NAME: [AppName] <br /> ADDRESS: 6007 ROCKEFELLER AVE ADDRESS: [AppAdd] <br /> EVERETT,WA,98203 [AppCi],[AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: DOSUNMU LUGBENGA <br /> PHONE: 2063712266 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? Iti YES 0 NO W.O.#: Ocl R3" <br /> Notes: Associated Bldg./PW Permit#: /7L7-157q. <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: ,9:4 _ <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 3/4'Detect Meter Only, 0 Fire Service Size <br /> aNO <br /> Explanation: age_ Explanation: <br /> 0[No RPBA Needed at premise -(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> J'An 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): <br /> SEWER FEE? <br /> ❑YES-Amount$ 0 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ErNO <br /> Explanation: OSF 6,38X41-ii <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES-Amount$ 0 See Attached Spreadsheet <br /> lit NO-No Change of Use/Other <br /> Explanation: Ivv 16,E `Ivr fiditk � Gh1 ht9me <br /> (Note:Public Works Reviewer to Add Traffic MitigationtoPW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES-Amount$ 0 See Attached Spreadsheet <br /> 14 NO IVO " '7�Z�, <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES-TYPE 0 See Attached Letter <br /> PW Reviewer: Date: <br /> (Wig <br /> REVISED 10/11/2016 <br />