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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/29/2016 <br /> Permit#: C1602-017 <br /> PROJECT ADDRESS: 3460 31ST DR j L��- %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#: ���/7�C'L� <br /> PW Permit Required?�YES ❑ NO W.O. #: <br /> � � <br /> Notes: Associated Bldg./PW Permit#: �l������.,�`(.�� Y, <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 Sfaff to Create Ufility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: 'p Q,� � FIRE SERVICE: <br /> �Y�—Amount$ "7C�'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$ '� .�"� �lew 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 Use/Other <br /> Explanation: �� �l'�J�r� �ffi.''�'i� v1V� ��i�: �}F�1�� <br /> (Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> YES—Amount$ � � ❑ See Attached S readsheet <br /> o No ;� ��� ,� ���,� �� y�z� /E <br /> `� <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ��YES—TYPE J .. �See Attached Letter <br /> ❑ NO <br /> _ , :�� �-� �/�S�-ld <br /> Public Works Reviewer Signature Dafe <br /> REvisEo 2izaizois <br />