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0.11ETTPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/28/2017 <br /> Permit#: PW1702-053 <br /> PROJECT ADDRESS: 3 '3 3 3DB z L07` -geo <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW TOWNHOME/TRAFFIC MITIGATION <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PNW Riverfront LLC <br /> ADDRESS: 11624 SE 5TH ST ADDRESS: 11624 SE 5th Street#200 <br /> BELLEVUE,WA,98005 BELLEVUE,WA, 98005 <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: nicka@polygonhomes.com <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PANT ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?)4 YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C /6o ek <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 /> ,ANO <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 /> OYES–Amount$ ���r 3 0 YES–Amount$ <br /> ,Meter Only, 0 Complete Service, Size 0 W Detect Meter Only, 0 Fire Service Size <br /> ❑ NO PCNO <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? Off' <br /> yYES–Amount$ /I/ ,New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> RYES–Amount$ X79'$ 0 See Attached Spreadsheet mj /Sim SOU. <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? ®o <br /> YES–Amount$ 351 0 See Attached Spreadsheet <br /> ❑ NO —,S'Le fl 3'&BP/a c/na it <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> )1;TYES–TYPE $PR %See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />