2101 ROCKEFELLER AVE 2017-01-18 - Laserfiche WebLink

4". PUBLIC WORKS REVIEW WORKSHEET (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/10/2016 Permit#: PW1603-025 PROJECT ADDRESS: 2101 ROCKEFELLER AVE DESCRIPTION OF WORK: FENCE IN THE RIGHT OF WAY CONTACT INFORMATION: OWNER: APPLICANT: NAME: [OwnName] NAME: [AppName] ADDRESS: [OwnAdd] ADDRESS: [AppAdd] [OwnCi], [OwnSt], [OwnZip] [AppCi], [AppSt], [AppZip] PHONE: [OwnPhone] PHONE: [AppPhone] EMAIL: [Own Email] EMAIL: [AppEmail] CONTACT: 0 Owner 0 Applicant ❑Other NAME: [ContactName] PHONE: [ContactPhone] EMAIL: [ContactEmail] COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: PW Permit Required? r+ YES 0 NO W.O.#: Notes: Associated Bldg./PW Permit#: FIRE SPRINKLER REQUIRED? (by Fire Department/Code) 0 YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) NO xplanation: (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) WATER FEES? DOMESTIC SERVICE: FIRE SERVICE: • IitYES—Amount$ 0 YES—Amount$ ❑ Meter Only, 0 Complete Service, Size 0 3/4' Detect Meter Only, 0 Fire Service Size NO ❑ NO xplanation: Explanation: ❑Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) Existing Utility Permit# (if applicable): SEWER FEE? ❑YES—Amount$ 0 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect �NO Explanation: Existing Utility Permit#(if applicable): SYSTEM DEVELOPMENT FEE? ❑YES—Amount$ 0 See Attached Spreadsheet te6NO—No Change of Use/Other Explanation: (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) TRAFFIC MITIGATION FEE? ❑YES—Amount$ 0 See Attached Spreadsheet VO ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) YES—TYPE 0 See Attached Letter NO l= _ ii Public r orks Reviewer Signatur Date REVISED 2/24/2016