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W + PUBLIC WORKS 1P <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/2/2017 <br />Permit #: PW1702-003 <br />PROJECT ADDRESS: 1031 SE EVERETT MALL WAY <br />DESCRIPTION OF WORK: CONSTRUCT PARKING LOT ADDITION / TRAFFIC MITIGATION <br />CONTACT INFORMATION: <br />OWNER: <br />APPLICANT: <br />NAME: EVERETT COVENANT GROUP LLC <br />NAME: MARGETICH JULIE A <br />ADDRESS: 17000 RED HILL AVE <br />ADDRESS: <br />IRVINE, CA, 92614 <br />PHONE: <br />PHONE: 9515825745 <br />EMAIL: <br />EMAIL: MARGETICHJ@PACIFICDENTAL.COM <br />CONTACT: ❑ Owner ❑ Applicant <br />NAME: [ContactName] <br />PHONE: [ContactPhone] <br />EMAIL: rcontactEmaill <br />❑Other <br />COMMENTS FROM PUBLIC WORKS REVIEWER: <br />PW Permit Required? $ YES ❑ NO <br />Notes: <br />LAND USE PROJECT <br />W.O. #: <br />Associated Bldg./PW Permit #: b / 7 0` C'CL <br />ES -Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br />aanatio�n '_ -b dot-,,-f 4t-),,k _wl -% _ck <br />(Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br />WATFR FFFR? <br />DOMESTIC SERVICE: FIRE SERVICE: <br />❑ YES - Amount $ ❑ YES - Amount $ <br />❑ Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size <br />NO A'NO <br />xplanation: Explanation: <br />RPBA Needed at premise? -(Plumbing permit for bj ckflow. C1 Iv�iicce needed due t � High -Hazard Site er Tim Markham's review) <br />❑ Water Department Cost Estimate Needed- 1 yes, PW Reviewer o send cost esti request to Water Department, attach copy) <br />Existing Utility Permit # (if applicable): <br />SEWER FEE? <br />❑ YES - Amount $ ❑ New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br />XN O <br />Explanation: <br />Existing Utility Permit # (if applicable): Z <br />YSTEM DEVELOPMENT FEE? 4 7 Ofo 5 c'r -4 lien 1-ca L C <br />YES -Amount$ ❑ See Attached Spreadsheet 4 1.73 P,, 194- <br />❑ NO - No Change of Use / Other <br />Explanation: <br />2672'PX Zc65= IR, 977,10'0- 2672-pi /, 72 = 4,�22.56 <br />TRAFFIC MITIGATION FEE? d— Add "e° bJ illciir' <br />,YES - Amount.$ ❑ See Attached Spreadsheet <br />❑ NO 4 l Z; 6 3 3 5ce 91"e-e i C i3-o r-r )Ml�k- z. Brl'ck <br />ADDRESS LETTER REQUIRED? <br />❑ YES - TYPE <br />'�_,(NO <br />PW Reviewer: <br />�I 1,2—✓Vol- <br />(If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />❑ See Attached Letter <br />Date: <br />REVISED 10/1112016 <br />-12-i7 <br />