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Alk <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 11/23/2016 <br /> Permit#: PW1611-03�, <br /> PROJECT ADDRESS: 9406 30TH DR SE LOT 3J <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?9 YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <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 /> J(NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Wafer/SewedSystem Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: //,,bb p o FIRE SERVICE. <br /> ❑YES–Amount$ ` 80— jar ❑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-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit# (if applicable): <br /> SEWER FEE? ap <br /> DYES–Amount$ 70— , New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? J1 1777 <br /> 'YES–Amount$ �7 � ❑ See Attached Spreadsheet <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? <br /> MYES–Amount$ 85�� ❑ See Attached Spreadsheet <br /> 0 N Z Per ehh4tL dg4ed 4 -2q- I(, <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br /> NYES–TYPE S' F/- , see Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> 2 <br /> REVISED 10/11/2016 <br />