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PUBLIC WORKS ��� �����_ ��� <br /> REVIEW WORKSHEET ` <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/29/2016 <br /> Permit#: C1602-016 <br /> PROJECT ADDRESS: 3458 31ST DR Lu� /Z� <br /> DESCRIPTION OF WORK: NEW TOWNHOME <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#: .��1,��/��C��; <br /> PW Permit Required?�YES ❑ NO w.0.#: <br /> Notes: Associated Bldg./PW Permit#: ����� ��'�x <br /> i i .� — �� <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: <br /> (Note: Counter Staff fo Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE:/,�r�I ,� FIRE SEf�VICE: <br /> �YES—Amount$ °�►!)V',,� �' �l ❑YES—Amount$ <br /> �(Meter Only, ❑ Complete Service, Size�_ ❑ 3/4" Deduct 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 /> �(YES—Amount$ ❑ See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: �t% ��Y L�t 1�J � ���� (y}Y� ��`i�� �`T (s4�i�• <br /> (Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> YES—Amount$ 3_ � •— ❑ See Attached Spreadsheet <br /> ❑ NO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> �'YES—TYPE S�'� $f See Attached Letter <br /> ❑ NO <br /> � '�.�— , <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />