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4En- PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/11/2017 <br /> Permit#: PW1709 040 <br /> PROJECT ADDRESS: , J--' 30TH DR L 4/ <br /> DESCRIPTION OF WORK: rSITE 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.#: J/ <br /> Notes: Associated Bldg./PW Permit#: C / O6 - 6?/ <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> 0 YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ONO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: p Q FIRE SERVICE: <br /> ❑YES—Amount$ 4�d 0 YES—Amount$ <br /> deter Only, 0 Complete Service, Size 4 ❑g/" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO ,rNO <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 /> 'YES—Amount$ *-7 <br /> 2 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE?/ /j 7"' <br /> ❑YES—Amount$ g796 0 See Attached Spreadsheet l`^ <br /> ❑ NO—No Change of Use I 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 Pc;Cl- QO'®_ 0 <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> %YES—TYPE S/''I�' ,Diree Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: ?_22—f7 <br /> �rI <br /> P <br /> REVISED 10/11/2016 <br />