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PUBLIC WORKS <br /> REVIEW WORKSHEET I�� � �D.� - � 4� <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/29/2016 <br /> Permit#: C1602-019 <br /> PROJECT ADDRESS: 3520 31 ST DR�L4 i I Z� — �C ��pS� � <br /> DESCRIPTION OF WORK: NEW TOWNHOME ' "L <br /> �j� To(�.%�15 a'� l�'���r�i o�r! <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 J <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <SUB l�—D� <br /> PW Permit Required?� YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: CI{lO_q�—OI I <br /> �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 /> ,Bl N O <br /> Explanation: <br /> (Note: Counter Staff fo Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> �D MESTIC SERVICE: /� ��C FIRE SERVICE: <br /> YES—Amount$ T�� `� ,� a ❑ YES—Amount$ <br /> ,�(Meter Only, ❑ Complete Service, Size� ❑ '/4" �educt 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? ��p <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 ���, C,�Fv�.T.s /� ��'� � <br /> ❑ NO—No Change of Use/Other /L3�rSx:c� �Hi S�Zf: �L/n r f. <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mifigation to PW Pennit(if applicable)) <br /> TRAFFIC MITIGATION FEE? �, <br /> '�1 YES—Amount$ �`�5% ❑ See Attached Spreadsheet <br /> ❑ rvo 5�=� �r�li ; � -�'f����;i ivl��� Br,c_k y�ZR��� <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,�,YES—TYPE S i=r� ,�'See Attached Letter <br /> ❑ NO <br /> ��1 �r�`t_ ��Z� �� <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />