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1 <br /> SATPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 5/11/2017 <br /> Permit#: PW1705-020 <br /> PROJECT ADDRESS: 5527 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: DIMICO JOE <br /> PHONE: 4257720694 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?k4 YES 0 NO W.O.#: -7 <br /> Notes: Associated Bldg./PW Permit#: C / /o I —.0 2Z__ <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 /> `NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: 1.4 d70 FIRE SERVICE: <br /> ❑YES—Amount$ ��3 0 YES—Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0 3/" Detect Meter Only, 0 Fire Service Size <br /> XNO1 ZI NO <br /> Explanation: Insin lled Gc917��, S o /���'f 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-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> EWER FEE? <br /> ❑YES—Amount$ 76 b New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 40/0C4r:3 fo �� a. Pied,f(Ai <br /> YES—Amount$ 8'776 0 See Attached Spreadsheet ,s;ee hataV ed j J nu,446r <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 i/Aey Paid et)/5401,4Mt,774 <br /> VNO <br /> vDDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> te'ES—TYPE .S'f-/€= <br />