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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/21/2015 <br /> Permit#: PW1510-039 <br /> PROJECT ADDRESS: 7016 BEVERLY BLVD <br /> DESCRIPTION OF WORK: SITE DEVELOPMENT FOR 2-LOT SHORT PLAT <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: EBERLE TROY NAME: EBERLE TROY <br /> ADDRESS: 14024 62ND AVE SE ADDRESS: 14024 62ND AVE SE <br /> EVERETT,WA,98208 EVERETT,WA,98208 <br /> PHONE: 2068527376 PHONE: 2068527376 <br /> EMAIL: EMAIL: <br /> CONTACT: Ei Owner 0 Applicant ❑Other <br /> NAME: EBERLE TROY <br /> PHONE: 2068527376 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: SS IS 002 <br /> PW Permit Required?.t YES 0 NO W.O.#: (a 02 20/5'O02 <br /> Notes: Su, PW 1510-03q -For Shod-rid Imp lVt>1ttlAssociated 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 /> 0N <br /> Explanation: 131) Lu1`/I . c. cut/p_! ossa Jfe on at') (of- ®rtes✓bld0 b?I <br /> (Note:Counter Staff to Create Utility P rmiy ater/Sewerr/System Development Fees) ✓�F-/� /)i. <br /> WATER FEES? <br /> DOMESTIC SERVICE: , FIRE SERVICE: <br /> tit YES—Amount$ 256,❑ Sitt YES—Amount$ <br /> 0 Meter Only, V(C6mplete Service, Size /7r ❑3/" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO 'NO <br /> Explanation: / tkit/05---0‘6 Explanation: <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 /> AYES—Amount$ , Q9 ,'New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect __ <br /> ❑ NO V' 1A ��POG bl(P <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> ,ENO—No Changen/ of Use/Other <br /> Explanation: S //go, 44 �� %�/l11�/ <br /> (Note:Public Works Reviewer to Add Traffic Mi i ation to PW Per)'ni (if <br /> gt applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> EYES—Amount$ ,9y00 0 See Attached Spreadsheet <br /> ❑ NO G•SEF proms-cgs a ' /1)fl . 074 sP iF-Cofl4. <br /> ADDRESS 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 /> 'NO f 0 i7sft/ h �F.s'rt/1'�. <br /> o s—/3—Rag <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />