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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/14/2016 <br /> Permit#: B1609-015 <br /> PROJECT ADDRESS: 6201 ASSOCIATED BLVD B-STE102 <br /> DESCRIPTION OF WORK: INTERIOR TI FOR NEW CONCRETE TILT-UP-COLUMBIA DISTRIBUTING <br /> CONTACT INFORMATION: <br /> OWNER: NAME: BROWN RANDY <br /> NAME: UNDERWOOD GARTLAND EVERETT LL ADDRESS: <br /> ADDRESS: 4210 132ND AVE NE <br /> BELLEVUE,WA, 98005-1115 PHONE: 4256461818 <br /> PHONE: EMAIL: RANDY- <br /> EMAIL: BROWN@SYNTHESISPLLC.COM <br /> APPLICANT: <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: BROWN RANDY <br /> PHONE: 4256461818 <br /> EMAIL: RANDY-BROWN@SYNTHESISPLLC.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? ❑ YES gNO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: .5 1060 y- <br /> FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br /> ❑YES-Type A (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO I �^ <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑YES-Amount$ ❑YES-Amount$ <br /> ❑ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size <br /> �NO ❑ NO <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$ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> XNO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? ge <br /> YES-Amount$—2 2 , (See Attached Spreadsheet <br /> ❑ NO-No Change of U e/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES-Amount$ ❑ See Attached Spreadsheet <br /> X•NO ter--- Cv L C e C fLI d PY'@ vsovS�jr <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned adc(ress), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES-TYPE ❑ See Attached Letter <br /> JS'NO <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />