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PUBLIC WORKS <br />REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/30/2017 <br />Permit #: PW1704• b��' <br />PROJECT ADDRESS: 7 7" � 5 3a� %j� SE LOT 3,Cj <br />DESCRIPTION OF WORK: SITE WORK AND TRAFFIC MITIGATION FOR NEW SFR <br />CONTACT INFORMATION: <br />OWNER: <br />APPLICANT: <br />NAME:' POLYGON WLH LLC <br />NAME: PANT ALAN / POLYGON <br />ADDRESS: 4695 MACARTHUR CT 8TH FLR <br />ADDRESS: <br />NEWPORT BEACH, CA, 92660 <br />, , <br />PHONE: <br />PHONE: 4255867700 <br />EMAIL: <br />EMAIL: <br />CONTACT: ❑ Owner ❑ Applicant ❑Other <br />NAME: PANI ALAN <br />PHONE: 4255867700 <br />EMAIL: ALAN.PANI@POLYGONHOMES.COM <br />COMMENTS FROM PUBLIC WORKS REVIEWER: <br />PW Permit Required? E3 YES ❑ NO <br />Notes: <br />LAND USE PROJECT #: <br />W.O. M <br />Associated Bldg./PW Permit Mr- 17O :5 ! 031 <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 />ONO <br />Explanation: <br />(Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br />WATER FEES? <br />DOMESTIC SERVICE: 00 FIRE SERVICE: <br />❑ YES — Amount $ �Iarl� — 3 '� ❑ YES — Amount $ <br />d Meter Only, ❑ Complete Service, Size ❑ %" Detect Meter Only, ❑ Fire Service Size <br />❑ NO 19 NO <br />Explanation: Explanation: <br />❑ RPBA Needed at premise? -(Plumbing permit for backflow device needed due to High -Hazard Site per Tim Markham's review) <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? o �► <br />§kYES — Amount $ 7a New Connection, ❑ Alteration/Repair, ❑ Cap-off/Reconnect <br />❑ NO <br />Explanation: <br />Existing Utility Permit # (if applicable): <br />SYSTEM DEVELOPMENT FEE? 1 <br />YES —Amount $. _6Z�k _ ❑ See Attached Spreadsheet / -7 <br />❑ NO — No Change of Use / Other <br />Explanation: <br />(Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit (if applicable)) <br />TRAFFIC MITIGATION FEE? 0. <br />OYES —Amount $ t3✓r�' ❑ See Attached Spreadsheet <br />❑ NO Pc? r k")ke $I— f c k e ky)c r C J a- ec 4 - 2,7— IL <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />YES — TYPE ,l see Attached Letter <br />NO <br />PW Reviewer: <br />Date: <br />—/ — J 7 <br />REVISED 1011112016 <br />