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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/23/2016 <br /> Permit#: PW1609-091 <br /> PROJECT ADDRESS: 3.414129TH,OR SE <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR BASIC/2015 IRC-RBI502-009-LOT 24 <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: POLYGON WLH LLC <br /> ADDRESS: 11624 SE 5TH ST SUITE 100 ADDRESS: 11624 SE 5TH ST SUITE 100 <br /> BELLEVUE,WA, 98005 BELLEVUE,WA, 98005 <br /> PHONE: 4255867700 PHONE: 4255867700 <br /> EMAIL: jamie.aubrey@gmail.com EMAIL: jamie.aubrey@gmail.com <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: ) lq-002 <br /> PW Permit Required? YES 0 NO W.O.#: <br /> Notes: Associated BIdgJPW Permit#: OAO ertr-O2t <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> 0 YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ,ONO <br /> Explanation: Cz'©g. <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> 'AYES—Amount$ L{$0, n 0 YES—Amount$ <br /> Iij'Meter Only, ❑ Complete Service, Size 3/y 0 3/4" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO ONO <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 /> OYES—Amount$ .°' gi New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> 9ifYES—Amount$ 11 q(®,U" 0 See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: 9022 ch <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> lit/YES—Amount$ $$4.pO ❑ See Attached Spread eet <br /> CINO 2 ow 0111ke, BEm- ll A-7-946) <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> [Et YES—TYPE S*F?Z V.See Attached Letter <br /> ❑ NO <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />