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ti <br /> 47T PUBLIC WORKS /-) 1 lc/2 <br /> r ozal- <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 12/22/2015 <br /> Permit#: C1512-007 <br /> PROJECT ADDRESS: 4925 OCEAN AVE <br /> DESCRIPTION OF WORK: NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLIpANT: <br /> NAME: ADAIR ENTERPRISES LLC NAME: OWNER <br /> ADDRESS: 15922 E SHORE DR ADDRESS: <br /> LYNNWOOD,WA, 98087 , , <br /> PHONE: 4253456437 PHONE: <br /> EMAIL: EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ®Other <br /> NAME: LESSLEY MATT <br /> PHONE: 4257431718 <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: <br /> PW Permit Required?EYES 0 NO LAND USE PROJECT#: <br /> Please provide explanation: W.O.#: <br /> Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> EYES—Type 13.1> (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> 0N <br /> Explanation: rt✓t d' �j�1'/cecoa7/290 Z0/2) 141/7 .7Loint''' <br /> et.P'0 „ <br /> / <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEE? , - <br /> Ar YES—Amount$ 'f;✓ �P t(D 0 Meter Only, Xl Complete Service,Type/Size I/1 DOM/ Y'2 <br /> EI NO J S <br /> Explanation: f to <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? 00 <br /> V YES—Amount$ 70. KNew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> Q NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? � - q--oCt <br /> AYES—Amount$ -3 1-64ilb 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 /> O YES—Amount$ Q See Attached Spreadsheet <br /> XNo /,Sfl (04 <br /> do c' 2-17-80 <br /> Public Works ,ewer Signature Date <br /> REVISED 12/16/2015— <br /> i / <br /> l <br />