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� + <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/13/2016 <br /> Permit#: PW1609-035 <br /> PROJECT ADDRESS: 3314 31ST DR LOT 91 <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 BIdgJPW Permit#: C/��L�—(7'�S <br /> FIRE SPRINKLER REQUIRED? (bv Fire Department/Code) <br /> ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> �'NO <br /> Explanation: F��.� �� <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FFES? <br /> UUii9L ;l�. :�i-I;VICt: i il<c ScKL'I�,IL: <br /> �YES—Amount$ �`l�(��`� ❑YES—Amount$ <br /> �"Meter Only, ❑ Complete Service, Size ❑ 3/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO _�l 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$ �,�'� $j New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENTFEE? <br /> �YES—Amount$ �. q E�, `� ❑ See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: �J y� �� <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> 6�YES—Amount$ �I•`'� ❑ See Attached Spreadsheet <br /> ❑ NO '� ��v'L �I J�lc� B. �m.a.f I <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> C�YFS—TYPF S�f' f�See Attached I_etter <br /> ❑ NO <br /> � �1 �— 3-�cY. <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />