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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 6/2/2017 <br /> Permit#: PW1706-003 <br /> PROJECT ADDRESS: 224 109TH ST SE <br /> DESCRIPTION OF WORK: GARAGE CONVERSION TO HABITAL FOR ADULT FAMILY HOME <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: NAMAMBA VINCENT 0&LUKANO NAME: BROWN FRED <br /> PATRICIA K ADDRESS: <br /> ADDRESS: 224 109TH ST SE <br /> EVERETT,WA, 98208-7012 PHONE: 2069924982 <br /> PHONE: EMAIL: <br /> EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?X.YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C... / 7Q5 1)03 <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> 0 YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> I,NO <br /> Explanation: <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 /> 152,NO I ,NO <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-(/f 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 /> 'ANO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? n s <br /> ('YES—Amount$ 2431 0 See Attached Spreadsheet IQCGeSSarjr Thf i IC ..DV) e I/iu 4ii°74 <br /> ❑ 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$ 0 See Attached Spreadsheet <br /> POO Less � ��frr`,S � eva [l-e Xe vv► <br /> f <br /> ADDRESS <br /> 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 /> XiNO <br /> PW Reviewer: KlA4‘,6Pv Date: <br /> REVISED 10/11/2016 <br />