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� � <br /> � PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/13/2016 <br /> Permit#: PW1609-030 <br /> PROJECT ADDRESS: 3304 31ST DR LOT 86 <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 /> PHONE: 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#:_ �/���, �U� <br /> FIRE SPRINKLER REQUIRED? (by Fire DepartmenUCode) <br /> ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> �NO <br /> Explanation: �I� �?� <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> i L1tJi�6'Ic:�1%l. SLf-��Vl�,c: �)c� 1 C'O i-�ii�c :�Li�'�i:l.c: <br /> iffi YES—Amount$ '-1 D�y ' 3/ �+ ❑ YES—Amount$ <br /> � Meter Only, ❑ Complete Service, Size P`� ❑ 3/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO $(NO <br /> Explanation: Explanation: <br /> ❑Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> �S(YES—Amount$ �.. �� I�New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> YES—Amount$ - � ❑ See Attached Spreadsheet <br /> ❑ NO—No Change of se/Other <br /> Explanation: I ��7� � <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> �S(YES—Amount$ ��� . � ❑ See Attached Spreadsheet <br /> ❑ N O � �,J.t j�'+6-�'= �• `' na.l� <br /> ��; <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> �YFS—TYPF <j�,.. �f See Attacheci Letter <br /> ❑ NO <br /> � ��� Y-l'3 -Z�1� <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />