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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/1/2016 <br /> Permit#: B1602-002 <br /> PROJECT ADDRESS: 3614 SMITH AVE � . > <br /> DESCRIPTION OF WORK: INTERIOR TI-NORTHWEST ZOOLOGICAL SUPPLY , v�L� �^'- ,}�l� <br /> 1 <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: NORTHBROOK PROPERTIES INC NAME: [AppName] <br /> ADDRESS: 555 SKOKIE BLVD SUITE 555 ADDRESS: [AppAdd] <br /> NORTHBROOK, IL, 60062 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <br /> CONTACT: ❑ Owner ❑ 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 ❑ NO W.O.#: $ ` � `�< � � � � �� <br /> � e � '. TD '_ � `'_ `; •�7i; ' ' <br /> Notes: , Assqciated Bld�./PW Permit# <br /> ( i� Y.ie� ' "` ,�"a�:i✓�. C�1�� a o�L � � <br /> \� e ?m e"�� aF b i `h' �� 'r..� 1'9�� ��.1: '.i..�.1�t'�l f".`.`-i �• "f !''.,.. � ! - <br /> nn.. � , ! ,r � = Y e�+i.-i . a� ,'7��h/,. .i r�"� ,.'"!�_;� <br /> f ir <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 /> (Nofe: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTlC SERVICE: FIRE SERVICE: <br /> ❑ YES-Amount$ ❑ YES-Amount$ <br /> ❑ Meter Only, ❑ Complete Service, Size ❑ '/4" Detect Meter Only, ❑ Fire Service Size <br /> �NO 1�NO <br /> Explanation: Explanation: <br /> ❑Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost estimate request to Water Department, atfach copy) <br /> Existing Utility Permit# (if applicable): <br /> SEWER FEE? <br /> ❑ YES-Amount$ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> �N� ; � � � � � <br /> Explanation: ' • <br /> Existing Utility Permit# (if applicable): <br /> SYSTEM DEVELOPMENTFEE? <br /> ❑ YES-Amount$ ❑ See Attached Spreadsheet <br /> �NO-No Change_of Usg/Other <br /> Explanation: <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 /> ,�N O , _., _ e .. :.- <br /> �i <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑ YES-TYPE ❑ See Attached Letter <br /> �NO <br /> i � ,v °� � ' `��° - -- <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2076 <br />