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4677- PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/30/2017 <br /> Permit#: PW1704. og g <br /> PROJECT ADDRESS: 3/Cto-gA-t St SE LOT lo Z <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@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?EI YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: ('1703 — 024, <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 /> 1:Si NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: p FIRE SERV/CE: <br /> ❑YES–Amount$ 487— `�� ❑YES–Amount$ <br /> it Meter Only, 0 Complete Service, Size i4- 0 3/" Detect Meter Only, 0 Fire Service Size <br /> 0N lEtNO <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 /> BYES–Amount$ /a >4 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> YES–Amount$. 1094-7 0 See Attached Spreadsheet 23;3 4 <br /> ❑ NO–No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> EYES–Amount$ t33�� 0 See Attached Spreadsheet <br /> 0N ��?Y h )ke 81-iek eic41, dais► 4 -Z(?--/L <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES–TYPE S7 R. ,i See Attached Letter <br /> NO <br /> PW Reviewer: C 6t( eQ Date: ^/ –1 <br /> .7 <br /> REVISED 10/11/2016 1 �'/ <br />