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4"7" PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 5/11/2017 <br /> Permit#: PW1705-021 <br /> PROJECT ADDRESS: 5529 BROADWAY <br /> DESCRIPTION OF WORK: NEW SFR DETACHED <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: FITZGERALD HAL D&DORIS NAME: DIMICO JOE <br /> ADDRESS: 3811 121ST PL SE ADDRESS: <br /> EVERETT,WA,98208 <br /> PHONE: PHONE: 4257720694 <br /> EMAIL: 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?"4 YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C/70/— 6.2-3 <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 /> XNO <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: LA 07011- 0 3 8 FIRE SERVICE: <br /> ❑YES-Amount$ 0 YES-Amount$ <br /> ❑,Meter Only, 0 Complete Service, Size 0 3/" Detect Meter Only, 0 Fire Service Size <br /> Explanation: 2s/ 1&d Lal S ho"7FPLd' Explanation: <br /> ❑ RPBA Needed at premise?-(P umbing 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 /> 1,-'SEWER FEE? <br /> „BYES-Amount$ 7© New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> YSTEM DEVELOPMENT FEE? A,�e4l S lo he a ni+ rk7 <br /> N'O'ES-Amount$ S'77‘, 0 See Attached Spreadsheet <br /> 0 NO-No Change of Use/Other `7OC+SL/CiereC,e `?e' s husnba�s <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 L/&Iy &/s N'i't <br /> AIN() <br /> ,DDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ttLYES-TYPE 0 See Attached Letter <br /> NO <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />