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4fir PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 5/19/2017 <br /> Permit#: C1705-017 <br /> PROJECT ADDRESS: 3317 WETMORE AVE BLDG 1 <br /> DESCRIPTION OF WORK: CONSTRUCT DUPLEX (A-i <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: MAJLESY NOSRAT NAME: OWNER <br /> ADDRESS: 109 2ND ST S ADDRESS: <br /> KIRKLAND,WA, 98033 , , <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: Associated Bldg./PW Permit#: pou17-05---of <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 any Water/Sewer/System Development Fees) <br /> NATER FEES? <br /> V DOMESTIC SERVICE: FIRE SERVICE: <br /> (YES—Amount$� �r 0 YES—Amount$ <br /> 0 Meter Only, Complete Service, Size l 0 3/4" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO )NO <br /> cplanation:_, Explanation: <br /> /y(ia❑ RPBA Neeuea at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> N(R- *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$ 7ek0 12'New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> VYSTEM DEVELOPMENT FEE? <br /> YES—Amount$ 3/ q 91, 0 See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other 1 / <br /> Explanation:DV -- (500s SFR 3 WI 0fl ( '1 r, V&A Sift; <br /> 2� (9's�9 <br /> tAte:Public Wo s`Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> AFFIC MITIGATION FEE? <br /> EYES—Amount$ ',�/�(�} 0 See Attached Spreadsheet <br /> ❑l NO WSOO .— of �yoo Ar Q hn1 am-bk.k. r =40'00 W9 ht <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address 401 <br /> fom TRAKiT Print Menu and include) <br /> ✓✓✓ trYES—TYPE D�O�PL£2C See Attached Letter .-'SQ-&r. I iLICEI <br /> ❑ N o331.4- (A)E"-t 1,81- NEI 0 fid' A- 4'8 4-��%l�t e o• rx�ro e� PO pi <br /> PW Reviewer: Date: <br /> 9pq v13- <br /> REVISED 10/11/2016 <br />