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477PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/18/2017 <br /> vverfrovr aVci, Permit#: PW1708. b/Z <br /> PROJECT ADDRESS: 442420 —SE �f-X' 22 <br /> DESCRIPTION OF WORK: SITE WORK FOR A 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? YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: 2 /76,7- 027 <br /> 7 <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 /> XNO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE; <br /> ❑YES—Amount$ 450 <br /> ©i j s7 0 YES—Amount$ <br /> ❑XNeter Only, 0 Complete Service,Size 4 0 3/"Detect Meter Only, 0 Fire Service Size <br /> ,NO <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 /> ,YES—Amount$ 74,42-- )(New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? -�+, ? 7 <br /> 0 <br /> ) 'YES—Amount$ /O 9¢T 0 See Attached Spreadsheet CJ G. <br /> ❑ NO—No Change of Us‘ Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> WNO <br /> Paid;i7 t' p' t'Iovst <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned acrdress), print out Address Letter from TRAKiT Print Menu and include) <br /> , "YES—TYPE ,.5"',c'2 " ❑ See Attached Letter <br /> ❑ NO <br /> PW Reviewer: 16, Date:1 <br /> RFVISFn 10/11/9016 <br />