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0 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 12/9/2016 <br /> Permit#: PW1612-021 <br /> PROJECT ADDRESS: 4323 30TH DR SE LOT 60 <br /> DESCRIPTION OF WORK: SITE WORK AND TRAFFIC MITIGATION FOR NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PANI ALAN/POLYGON <br /> ADDRESS: 4695 MACARTHUR CT 8TH FLR ADDRESS: <br /> NEWPORT BEACH, CA, 92660 <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: <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#: <br /> PW Permit Required?)(YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: /Z-00 <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 /> XNO <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: CC FIRE SERVICE: <br /> ❑ YES—Amount$ _186 3 ❑YES—Amount$ <br /> X Meter Only, ❑ Complete Service, Size4- ❑ 1/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO ,B('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-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? pp <br /> ,4'YES—Amount$ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit# (if applicable): <br /> SYSTEM DEVELOPMENT FEE? C' <br /> RYES—Amount$ (IcI/l) ❑ See Attached Spreadsheet 20 92 <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? C' <br /> ,,M*YES—Amount$ 154- ❑ See Attached Spreadsheet <br /> ❑ NO <br /> A -- Per r hq i kc C.rn a r C c;-f Q d 4 1. -I� <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br /> , 'YES—TYPE 6'i ,1� See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: 12, �/,6 <br /> REVISED 10/11/2016 <br />