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4E77PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/18/2017 <br /> _2-4 Permit#: PW1708.96 <br /> PROJECT ADDRESS: 40 29TH AVE SE LAi-/- 0769 <br /> DESCRIPTION OF WORK: SITE WORK FOR A 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@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: £ /70 7 Dd z.. <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 /> XNO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: ©8 FIRE SERVICE: <br /> j <br /> ❑YES—Amount$ �! ❑YES—Amount$ <br /> ❑ `Meter Only, 0 Complete Service, Size 4 0 1"Detect Meter Only, 0 Fire Service Size <br /> NO 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? <br /> `YES—Amount$ 7a lew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 235-30 <br /> )(YES—Amount$ /0/94 7 0 See Attached Spreadsheet <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 /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> WNO • <br /> Paid Ade pr'et/C©U.SC <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned a&ress), print out Address Letter from TRAKiT Print Menu and include) <br /> ,, rYES—TYPE oS/lR' 0 See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> RFW FD 10/11/2()16 <br />