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4.77. PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 6/29/2017 <br /> Permit#: PW1706-O 8 <br /> PROJECT ADDRESS: 4923 30TH DR SE Lo064 <br /> DESCRIPTION OF WORK: SITE WORK FOR A NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PANT 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#: 2 /71-9G "0/4- <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: pC FIRE SERVICE: <br /> ❑YES—Amount$ 460- yr 0 YES—Amount$ <br /> 'Meter Only, 0 Complete Service, Size 4 0 3/4"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO ONO <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? �p <br /> X(YES—Amount$ 70 KNew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 2027 1t' <br /> EYES—Amount$ /0/917 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? oO <br /> ❑YES—Amount$ ' 0'-` 0 See Attached Spreadsheet <br /> ENO Paid 46-'ea& <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address),print out Address Letter from TRAKiT Print Menu and include) <br /> I., YES—TYPE S/ ie %See Attached Letter <br /> ❑ NO <br /> PW Reviewer: /� Date: <br /> 6 -3O-/7 <br /> REVISED 10/11/2016 <br />