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477PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/17/2016 <br /> Permit#: B1608-077 <br /> PROJECT ADDRESS: 1309 HEWITT AVE <br /> DESCRIPTION OF WORK: TI FOR NEW COFFEE SHOP <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: HARRISON WARREN/SPOELSTRA NAME: [AppName] <br /> CHAR ADDRESS: ADDRESS: [AppAdd] <br /> 4081 SALT SPRING DR [AppCi], [AppSt], [AppZip] <br /> FERNDALE,WA,98248 PHONE: [AppPhone] <br /> PHONE: EMAIL: [AppEmail] <br /> EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#:_ <br /> PW Permit Required? 0 YES XO W.O.#: <br /> Notes: NO PtdOimbrejt.A.A (,O fh6trillAir Wtrf , Associated Bldg./PW Permit#: 7 <br /> FIRE SPRINKLER REQUIRED?(by 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 to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑YES-Amount$ 0 YES-Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0 3/4"Detect Meter Only, 0 Fire Service Size <br /> pli NO 'NO <br /> Explanation: Explanation: <br /> ❑Water Department Cost Estimate Needed-(/f 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 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 18(NO <br /> Explanation: ___ <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> NrYES-Amount$ tf g 7o. at lerSee Attached Spreadsheet <br /> ❑ NO-No Change of Use/Other <br /> Explanation: equk€ ffu t <br /> ( soo s -) -f b ci a I4a2 ' S S <br /> (Note:Public Works Reviewer to Add Tr Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES-Amount$ 0 See Attached Spreadsheet <br /> X NO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES-TYPE 0 See Attached Letter <br /> li[NO <br /> 41(itialtEA__- 9—/y— Q/6 <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />