Laserfiche WebLink
An. PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/6/2017 <br /> Permit#: PW1707-005 <br /> PROJECT ADDRESS: 2220 GIBSON PL <br /> DESCRIPTION OF WORK: NEW SFR DETACHED <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: HUMMER DAVID AND STEPHANIE NAME: HUMMER DAVID AND STEPHANIE <br /> ADDRESS: 2115 KIRBY PLACE ADDRESS: 2115 KIRBY PLACE <br /> EVERETT,WA, 98203 EVERETT,WA,98203 <br /> PHONE: 9104891353 PHONE: 9104891353 <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: GROTH ELAINE SIMONS <br /> PHONE: 4258764447 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?BYES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C/706 _oo/ <br /> FIE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> O <br /> Explanation: ctrl CSD de - wo `FLw n a.i0(.C.t/t eI <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? �+ <br /> DOMESTIC SERVICE: Cos"7.Gi'0e"2)10/71 t T�/''e FIRE SERVICE; <br /> RYES—Amount$ z 29 'i>°an ❑YES—Amount$ <br /> 0 Meter Only, Complete Service, Size / <br /> 0 3/4" Detect Meter Only, 0 Fire Service Size <br /> 0 N CI 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? 0 b <br /> Ar.YES—Amount$ 7D' JNew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> v SYSTEM DEVELOPMENTFEE? 3f 0 C43 <br /> YES—Amount$ /® 94 7 ❑ See Attached Spreadsheet <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 /> ❑ NO pet ICY to/.S6o14P(4f <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,rYES—TYPE SFR ) 'Bee Attached Letter <br /> 0 N <br /> PW Reviewer: Date: <br /> Hip- 4 9-/i -/ 7 <br /> REVISED 10/11/2016 <br />