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� <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/13/2016 <br /> Permit#: PW1609-032 <br /> PROJECT ADDRESS: 3308 31ST DR LOT 88 <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#: G � 'G <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 /> '.�NO <br /> Explanation: �� �� <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> UDit�iLs l iC; 51 r;'v'iC;-: � FII�< <_I:''il 'E: � <br /> �YES Amount$ ��.-' �/ �' ❑ YES—Amount$ <br /> $fMeter Only, ❑ Complete Service, Size �I'� ❑ 3/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO `�(NO <br /> Explanation: Explanation: <br /> ❑Water Department Cost Estimate Needed-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE� <br /> �YES—Amount$ ���'� �New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENTFEE? <br /> B(YES—Amount$�� ',� .�"_ ❑ See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: �j�� � <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑ YES—Amount$ :�i �.� ❑ See Attached Spreadsheet <br /> ❑ NO � �� �� � �'t�lQ.�� <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> �(YES TYPF SF� �(See Attached Letter <br /> ❑ NO <br /> �'—�3 �Zol�� <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />