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47rPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/14/2016 <br /> Permit#: C1603-O'J <br /> PROJECT ADDRESS: 3119131ST DR <br /> DESCRIPTION OF WORK: NEW TOWNHOME LOT 121 BLDG 1} <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: POLYGON WLH LLC <br /> ADDRESS: 11624 SE 5TH ST SUITE 100 ADDRESS: 11624 SE 5TH ST SUITE 100 <br /> BELLEVUE,WA,98005 BELLEVUE,WA,98005 <br /> PHONE: 4255867700 PHONE: 4255867700 <br /> EMAIL: EMAIL: <br /> CONTACT: ❑ Owner ❑ Applicant DOther <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANIca POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? YES 0 NO W.O.#: <br /> Notes: Associated BIdgJPW Permit#: OISO�' `031 <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 /> Explanation: rim ('AIE, <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> EYES—Amount$ 506.'10 JJ d YES—Amount$ <br /> li Meter Only, ❑Complete Service, Size 3/',f 0 3/"Detect Meter Only, 0 Fire Service Size <br /> 0 N sfNO <br /> Explanation: Explanation: <br /> NIS RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> Al 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 /> It YES—Amount$ 701 4 It:New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> iv—SYSTEM DEVELOPMENT FEE? <br /> 114 YES—Amount$ ❑ See Attached Spreadsheet <br /> ❑ NO—No Change/ of Use/Other <br /> Explanation: /311/ q wn/ m_ &SUL S % ee) <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ ❑ See Attached Spreadsheet <br /> KNO Att ?OA JnpiA <br /> /ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> It YES—TYPE 7VGUNH0I176 I&i See Attached Letter x ISCQiI.R,l.A011J E -10 Je Maas <br /> ❑ NO `411E O C �1° permit-" lleaA copy <br /> PW Reviewer: / / I / Date: <br /> 4; ha_ � s 3 8 2©IS <br /> REVISED 10/11/2016 <br />