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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/14/2016 <br /> Permit#: PW1609-058 <br /> PROJECT ADDRESS: 3315 30TH DR <br /> DESCRIPTION OF WORK: NEW TOWNHOME/TRAFFIC MITIGATION LOT 84 <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#: c�6�7—�J�f'' <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 /> '�N O <br /> Explanation: �(f�E �� <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> 1nIATFR FEFS? <br /> DO�F_STIC SERVICE: 't � FIRE SERVICE: i <br /> �YES—Amount$ �1���' �� ❑YES—Amount$ <br /> �[Meter Only, ❑ Complete Service, Size 3�� ❑3/<" Detect Meter Only, ❑ Fire Service Size <br /> C]�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$ �0�� I�;New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENTFEE? <br /> �YES—Amount$ '��g( n'� ❑ See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: ���t� <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FE ? <br /> �YES—Amount$ . � ❑ See Attached Spreadsheet <br /> ❑ N O � �/�/ ���� G�- `��o'I.su l <br /> �. " - <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> �YES—TYPE �� �See Attached Letter <br /> ❑ NO <br /> ��- � � �'' � � . <br /> ublic Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />