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glib, Adlk <br /> PUBLIC WORKS IRW <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 12/9/2016 <br /> Permit#: PW1612-023 <br /> PROJECT ADDRESS: 4325 30TH DR SE LOT 61 <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?,q YES ❑ NO W.O.#: <br /> Notes: Associated Bldg.IPW Permit#: C /612 003 <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 /> XN O <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: /J �0 FIRE SERVICE: <br /> ❑ YES—Amount$ —T 8Ly j' i ❑YES—Amount$ <br /> RMeter Only, ❑ Complete Service, Size ❑3/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO XNO <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? 00 <br /> "YES—Amount$ ZO New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 7 <br /> ,DYES—Amount$ e?9110 ❑ See Attached Spreadsheet G 819 <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? oc <br /> )K'YES—Amount$ X3.54 ' ❑ See Attached Spreadsheet <br /> ❑ NO — Pzr r";ke 6,-ick P, nut d,-4ed y Z I-1 b <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br /> WYES—TYPE �' f— J0 See Attached Letter <br /> ❑ NO <br /> PW Reviewer: lv� Date: iz 41 <br /> REVISED 10/11/2016 <br />