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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/21/2016 <br /> Permit M PW1609-083 <br /> PROJECT ADDRESS: 4407 29TH DR SE <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR BASIC/2015 IRC -RB1502-009-LOT 19 <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: POLYGON WLH LLC <br /> ADDRESS: 11624 SE 5TH ST SUITE 100 ADDRESS: 11624 SE 5TH ST SUITE 100 <br /> BELLEVUE,WA, 98005 BELLEVUE,WA, 98005 <br /> PHONE: 4255867700 PHONE: 4255867700 <br /> EMAIL: jamie.aubrey@gmail.com EMAIL: jamie.aubrey@gmail.com <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: ��.1>��"lr�•�C <br /> PW Permit Required? DYES ❑ NO W.O.#: tv <br /> Notes: Associated Bldg./PW Permit#: C-����'��U <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 /> E'N O <br /> Explanation: C� <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: Y� FIRE SERVICE: <br /> Er-YES—Amount$ �l� 3 ❑YES—Amount$ <br /> i�Meter Only, ❑ Complete Service, Size_ ❑ 3/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO E(NO <br /> Explanation: Explanation: <br /> ❑Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> k YES—Amount$ X New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> 19YES—Amount$ cl 0 9 10, ❑ See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: (��02 <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> 1RrYES—Amount$ 3 S , ❑ See Attached Spreadsheet <br /> ❑ NO �P AJ*_J_' ,g e'f7 1 �-4-29-2014) <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> t(YES—TYPE_ 3F` Z_ Ild See Attached Letter <br /> ❑ NO <br /> 2- — <br /> 44L� :��J/ ? <br /> Public orks Reviewer Signature Date <br /> REVISED 2/24/2016 <br />