4308 RIVERFRONT BLVD 2018-02-21 - Laserfiche WebLink

PUBLIC WORKS • REVIEW WORKSHEET (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/30/2016 Permit#: PW1607-058 PROJECT ADDRESS: 4319 29TH DR SE LOT 107 DESCRIPTION OF WORK: SITE WORK AND TRAFFIC MITIGATION FOR NEW SFR CONTACT INFORMATION: OWNER: APPLICANT: NAME: POLYGON WLH LLC NAME: PANI ALAN/POLYGON ADDRESS: 4695 MACARTHUR CT 8TH FLR ADDRESS: NEWPORT BEACH, CA, 92660 PHONE: PHONE: 4255867700 EMAIL: EMAIL: CONTACT: ❑ Owner ❑ Applicant []Other NAME: PANI ALAN PHONE: 4255867700 EMAIL: ALAN.PANI@POLYGONHOMES.COM COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT M PW Permit Required?, YES ❑ NO W.O.#: / Notes: Associated Bldg./PW Permit#: C 160 7 dZ FIRE SPRINKLER REQUIRED? (by Fire Department/Code) ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) XNO Explanation: (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) WATER FEES? DOMESTIC SERVICE: Da FIRE SERVICE: ❑ Y S—Amount$ � j ❑YES—Amount$ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size ❑ NO 2i(NO Explanation: Explanation: ❑Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) Existing Utility Permit#(if applicable): SEWER FEE? )l YES—Amount$ 7Z) ❑ New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect ❑ NO Explanation: Existing Utility Permit#(if applicable): SYSTEM DEVELOPMENT FEE? y`0 RYES—Amount$_��(Q� ❑ See Attached Spreadsheet ❑ NO—No Change of Use/Other Explanation: (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) TRAFFIC MITIGATION FEE?.d firYES—Amount$ d ❑ See Attached Spreadsheet ❑ NO Per l- 14.16 ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) A YES—TYPE s'�� ,�See Attached Letter ❑ NO 7-S,0-16 Public Works Reviewer Signature Date REVISED 2124/2016