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4677 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/21/2018 <br /> Permit#: PW1802-023 <br /> PROJECT ADDRESS: 2412 MAPLE ST <br /> DESCRIPTION OF WORK: SITE PAVING FOR PARKING STALLS FOR DADU <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: ROSENBERG MARILYN A NAME: ROSENBERG MARILYN A <br /> ADDRESS: 2410 MAPLE ST ADDRESS: 2410 MAPLE ST <br /> EVERETT,WA,98201-3224 EVERETT,WA, 98201-3224 <br /> PHONE: PHONE: <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? YES 0 NO W.O.#: <br /> Notes: eavim Di Associated Bldg./PW Permit#: 4 MO O—BO1 <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: <br /> (Note:Counter Staff to Create Utility Permit for an Water/S �r//System Develgprpent F es 4J <br /> NATER FEES? -� QIZitreAttigIRE <br /> 77 �L(a 710 CApt H , - ,",,�.,jy�DOMESTIC SERVICE+' 1 I' ` J,� SERVICE: y_ _ <br /> W'`� <br /> o YES—Amount$ ^"^""' 1• D YES—Amount$ <br /> ❑ Meter Only, 0 Complete Service, Size 0 3/4'Detect Meter Only, 0 Fire Service Size <br /> lieNO *(NO <br /> Explanation: Explanation: <br /> IJO'RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> NIi 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 /> VSEWER FEE? <br /> EYES—Amount$ " 0 New Connection, Alteration 'epair, 0 Cap-off/Reconnect <br /> NO <br /> Explanation: ,l , MU fv FAMMAI S?AJEr <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> rd t'YES—Amount$ a4(,/. 0 See Attached Spreadsheet <br /> ❑ NO—No Change oflUse/Other <br /> Explanation: NEW Df*U ( L - secure e,Aa ge-) <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 /> ENO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Let er fr om TRAKiT Print Menu and include) <br /> EYES—TTY�PEnSM.S . ) 'See Attached Letter X Q (i a fo IVO p&ni <br /> K? .v <br /> ❑ NO 2 01# ' (6SC'A/l to JEf"rre9. M des-a ,t 24s jat <br /> PW Reviewer: It Date: <br /> jl / o� a24�8 <br /> REVISED 10/11/2016 <br />