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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/30/2017 <br /> Permit#: A11704- 04O <br /> PROJECT ADDRESS: 44 v3-351-Avg SE LOT 61- <br /> DESCRIPTION <br /> -DESCRIPTION OF WORK: SITE WORK AND TRAFFIC MITIGATION FOR NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PANI ALAN/POLYGON <br /> ADDRESS: 4695 MACARTHUR CT 8TH FLR ADDRESS: <br /> NEWPORT BEACH,CA, 92660 , , <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI acPOLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?El YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: (7/703 — O2 Z <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: Od FIRE SERVICE: <br /> ❑YES–Amount$ ' 8C— 0 YES–Amount$ <br /> it Meter Only, 0 Complete Service, Size -"4- 0 g/" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO 'i 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-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? O O <br /> ikYES–Amount$ 7Q— I New Connection, 0 Alteration/Repair, ❑ Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> YES–Amount$_ /O.) 94 7 0 See Attached Spreadsheet 2 8 1 S 4i <br /> ❑ NO–No Change of Use Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> EYES–Amount$ 8,-7- 0 See Attached Spreadsheet <br /> ❑ NO - Per v)4lk-e. jg7Leci 4 -z? 14, <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES–TYPE S'PR' ,>~yf'See Attached Letter <br /> NO <br /> PW Reviewer: ; O Date: <br /> REVISED 10/11/2016 / o�� <br />