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coserr <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/11/2017 <br /> Permit#: PWI709 04- <br /> PROJECT ADDRESS: ? te 30TH DR Of 42 <br /> DESCRIPTION OF WORK: 3�TE WORK FOR NEW TOWNHOME <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PNW Riverfront LLC <br /> ADDRESS: 11624 SE 5TH ST ADDRESS: 11624 SE 5th Street#200 <br /> BELLEVUE,WA,98005 BELLEVUE,WA, 98005 <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: nicka@polygonhomes.com <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?YES 0 NO W.O.#: ,*/ <br /> Notes: Associated Bldg./PW Permit#: C /606 - e Z. <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ©YES—Type (If yes,add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp/lino <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: © 0 FIRE SERVICE: <br /> ❑YES—Amount$ 43t ❑YES—Amount$ <br /> 'llleter Only, 0 Complete Service, Size 4 0 3/" Detect Meter Only, 0 Fire Service Size <br /> ❑ 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? <br /> ae <br /> JIVES—Amount$ 7a )'New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? /33L 7" <br /> ❑YES—Amount$ 0794 0 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 /> iltrNO � ;G'/ Qt-Q a l <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> %YES—TYPE S pg. ee Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> Z2-17 <br /> erk- <br /> REVISED 10/11/2016 <br />