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iii•477 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/28/2017 <br /> Permit#: PW1702-05¢ <br /> PROJECT ADDRESS: �3 y` O�-��� Ler/ 2 7� <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: PANI 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 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C 160 4- 107 <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 /> ,I NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: B® FIRE SERVICE: <br /> ❑YES-Amount$ 781)— 3 0 YES-Amount$ <br /> ,Meter Only, ❑Complete Service,Size 0%"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO , ACNO <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? Elp <br /> ,'YES-Amount$ /V ,(New Connection, ❑Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> , YES-Amount$ R7946 0 See Attached Spreadsheet /..o.m Aruse <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? ®e <br /> )'YES-Amount$ 35-1 0 See Attached Spreadsheet <br /> ❑ NO IL—See 67'1% gi-IC,F e671t�Tt <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> n'ES-TYPE 'I / %See Attached Letter <br /> ❑ NO47Al7, dl <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />