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PUBLIC WORKS � <br /> REVIEW WORKSHEET �/j� T c���s ct`E- �rver�%�c-��� <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/11/2016 <br /> Permit#: PW1609-022 <br /> PROJECT ADDRESS: 3302 31ST DR LOT 85 <br /> DESCRIPTION OF WORK: NEW TOWNHOME/TRAFFIC MITIGATION <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PNW Riverfront LLC <br /> ADDRESS: 11624 SE 5TH ST ADDRESS: 11624 SE 5th Street#200 <br /> BELLEVUE,WA, 98005 BELLEVUE,WA, 98005 <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: nicka@polygonhomes.com <br /> CONTACT: ❑ Owner ❑ Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHON E: 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#: �/(���o ""��o/ <br /> FIRE SPRINKLER REQUIRED?(bv Fire DepartmenUCode) <br /> ❑YES–Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> �„NO <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> VVATER FEES? <br /> DOMES fIC SERVICt: C�C� FIKE SEF�VICE: <br /> ❑ YES–Amount$ �`�U J 3 '' ❑YES–Amount$ <br /> �Meter Only, ❑ Complete Service, Size�(� ❑ 3/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO �"NO <br /> Explanation: Explanation: <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? ��� <br /> ��[�YES–Amount$ �].�/ — .�New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? ��f� J <br /> ,�YES–Amount$ 79<v Z ❑ See Attached Spreadsheet ��4� <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? Qp <br /> ,�(YES–Amount$ �S� ❑ See Attached Spreadsheet <br /> ❑ No �C �� �Ke l�. �yr�cr�L. <br /> � �r ��i <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> �3(Y�S–TYPE S�=/Z �See Attached Letter <br /> ❑ NO <br /> �� � -/Z -%� <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />