Laserfiche WebLink
PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/21/2016 <br /> Permit#: PW1609-081 <br /> PROJECT ADDRESS: 3021 44TH ST SE <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR BASIC/2015 IRC -RB1502-004-LOT 64 <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#: �JU9N-00�) <br /> PW Permit Required? I9 YES ❑ NO W.O.#: nn I <br /> Notes: Associated Bldg./PW PermitMe—l�Oq <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 /> )KNO <br /> Explanation: �y_e- C-me <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: I tFIRE SERVICE: <br /> AYES—Amount$ �'{g`{�9 ❑YES—Amount$ <br /> WMeter Only, ❑ Complete Service, Size_ ❑ %" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO `Pf NO <br /> Explanation: Explanation: <br /> ❑Water Department Cost Estimate Needed-(/fyes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> 115�YES—Amount$_ % g New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> 8f YES—Amount$ 7, TO I •`� ❑ See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other n <br /> Explanation: �(3S3 <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> IKYES—Amount$ ` ❑ See Attached Spreadsheet <br /> ❑ NO P- l7'lK� 6 FimaJI 1 Y-Z 9-U) <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), printout Address Letter from TRAKiT Print Menu and include) <br /> -V YES—TYPE 8f See Attached Letter <br /> ❑ NO <br /> A2 W <br /> Public Works Reviewer Signature Date <br /> REVISED 2124/2016 <br />