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Y\06\14 <br /> ign" PUBLIC WORKS P <br /> REVIEW WORKSHEET En-/areo! <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/15/2016 <br /> Permit#: B1604-029 <br /> PROJECT ADDRESS: 6201 ASSOCIATED BLVD(j3t i B) 4 <br /> DESCRIPTION OF WORK: NEW CONCRETE TILT-UP Plitt 6,0 f os 3 <br /> CONTACT INFORMATION: /7QGr�� <br /> OWNER: NAME: BROWN RANDY <br /> NAME: UNDERWOOD GARTLAND EVERETT LL ADDRESS: <br /> ADDRESS: 4210 132ND AVE NE <br /> BELLEVUE,WA, 98005-1115 PHONE: 4256461818 <br /> PHONE: EMAIL: RANDY- <br /> EMAIL: BROWN@SYNTHESISPLLC.COM <br /> APPLICANT: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: BROWN RANDY <br /> PHONE: 4256461818 ,'/f <br /> EMAIL: RANDY-BROWN@SYNTHESISPLLC.COM 'j4 h 011$4 ( ;via Ptv( 0't 024 <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: (cfJ <br /> PW Permit Required?V'YES 0 NO W.O.#: <br /> Notes: °L Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> N[YES—Type (If yes,add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? Se," VseeS <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> )(YES—Amount$ 8804 OYES—Amount$ SO %s <br /> ❑ Meter Only, Complete Service, Size 2d X%"Detect Meter Only, 0 Fire Service Size /2 <br /> ❑ 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 /> C Jh fit r490r490", Oo/Au ha retiree O{71 v'c 'Yyd h0 es//mss:ate <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? 00 <br /> OYES—Amount$ 7D X New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? Zoo/ P <br /> RYES-Amount$ /8) ¢96 EL. 0 See Attached Spreadsheet // <br /> ❑ NO—No Change of Use/Other X 0,47 r 2 2 (Wei/ye 4ovsej <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> 'DYES—Amount$ 157 J 463 0 See Attached Spreadsheet <br /> o NO Set- COr c, �ivyi re.V0ecd¢oi t c)l76, Mae <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,YES—TYPE CoMNI. ASee Attached Letter <br /> ❑ NO <br /> y- z z-; <br /> Public Works eviewer Signature Date <br /> REVISED 2/24/2016 <br />