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Oren. PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/23/2016 <br /> Permit#: PW1609-089 <br /> PROJECT ADDRESS: ....„.„:„.444 DR SE ,, <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR BASIC/2015 IRC-RB1502-009-LOT 23 <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#: v3/'7 3/11--0612- <br /> PW Permit Required? Ni YES 0 NO W.O.#: / <br /> Notes: Associated Bldg./PW Permit#:C/D 0 cl-02 <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 /> gNO <br /> Explanation: n -' <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> k"YES-Amount$ 93j II 0 YES-Amount$ <br /> 'Meter Only, 0 Complete Service, Size /-I 0 W Detect Meter Only, 0 Fire Service Size <br /> ❑ NO tjit 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 /> EYES-Amount$ .°- IKNew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> EYES-Amount$ 1;110 0 See Attached Spreadsheet <br /> ❑ NO-No Change of Use/Other <br /> Explanation: l <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> El YES-Amount$ )511,434 0 See Attachereadsheet <br /> ❑ NO 1 e - Arl <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> EYES-TYPE SFe-- 'I (See Attached Letter <br /> 0N <br /> ?-23—Zee <br /> Public Works Reviewer Signature Date <br /> REVISED 2/24/2016 <br />