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PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 2707 COLBY AVE STE 718 Permit#: B1811-046 <br /> TENANT: DAVITA NEPHROLOGY PRACTICE <br /> DESCRIPTION OF WORK: TENANT IMPROVEMENT TO CREATE MEDICAL FACILITY <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> ❑ New Connection to main plus connections to building 0 New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair 0 Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity 0 Sewer System Development Fee Total:$ <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve ❑ Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> 'KNOT REQUIRED KNOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4"Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ ❑ Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA it(NOT REQUIRED <br /> :NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-Of yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> ❑ NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> pjf NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> ❑YES, Stormwater Total:$ AYES,Traffic Mitigation Total:$ / /04 <br /> ❑ See Attached Spreadsheet for calculations juSee Attached Spreadsheet for calculations/credit <br /> RIOT REQUIRED 0 NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES–TYPE: 0 SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> ❑ Saved to Address Folder in Development Tech File <br /> KNOT REQUIRED <br /> FI E SPRINKLERS REQUIRED? <br /> YES–Type <br /> ❑ NOT REQUI E 11 r (?� <br /> Reason: i VX1 514 (k1i/V lq I�AAAJ�^r <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW <br /> ❑ Stormwater NPDES T . impleted in TRAKiT 0 ADA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> PINOT REQUIRED <br /> Adol <br /> Worksheet Completed By: -� � — �� Date: 0 Z LZ <br /> Worksheet Checked By: �� p y Date: '2 22 to j <br /> REVISED 2/22/2019 <br />