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04' PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/9/2018 <br /> Permit#: B1803-020 <br /> PROJECT ADDRESS: 1817 BROADWAY <br /> DESCRIPTION OF WORK: SHEET ROCK-STATE FARM OFFICE <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: JONES CHRIS NAME: [AppName] <br /> ADDRESS: 18827 BOTHELL WAY NE#103 ADDRESS: [AppAdd] <br /> BOTHELL,WA,98011 [AppCi], [AppSt], [AppZip] <br /> PHONE: 2068412815 PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CHRIS.JONES.UJM1 @STATEFARM.COM <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? 0 YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <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: .�r/L, (�C�izgAr M1 <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 /> EExplaanation:5C S ti(tht .'k , r A 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$ 1/ , 0 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> /11NO <br /> Explanation:I ?C 161/ g r._ _ - —• <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> IZNO—No Change of Use/Other / _ <br /> Explanation: wn � <br /> I' ` O _IS4/iC4LtTf/�C1e/f/M -./ 7f., ,,,, <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> 5(NO• Amount$Oj P� has /i 0 See.tAt_tachZ[eysi�S_pread�irte r %0 , �4 �, <br /> ADDRESSLETTER REQUIRED? (If yes(new as,�Csignned adr�dress), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE 0 See Attached Letter <br /> B'NO <br /> PW Reviewer: <br /> < Date: �jg�0 <br /> REVISED 10/11/2016 w� <br />