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477 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/1/2017 <br /> Permit#: PW1703-c P6 <br /> PROJECT ADDRESS: S3'+ - 30th Dr LOT r Z <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#: G l D'4- /1/— <br /> PW <br /> llPW Permit Required? I YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: <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 /> xplanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: a� h FIRE SERVICE: <br /> ❑YES—Amount$ -S© > �/ 0 YES—Amount$ <br /> ❑ llMeter Only, 0 Complete Service, Size �j�' 0 3/" Detect Meter Only, 0 Fire Service Size <br /> O etNO <br /> Explanation: Explanation: <br /> O 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? yy��,,,, vvoll, <br /> YES—Amount$ Tv /t, KNew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> 1*'YES—Amount$ � •*-q10. 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 /> YES—Amount$ 3S/ 0 See Attached Spreadsheet izdtiztei /��j <br /> ' ow <br /> NO <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> IlfYES—TYPE S 0 See Attached Letter <br /> ❑ NO <br /> PW Reviewer: p.47.11 Date: I <br /> REVISED 10/11/2016 <br />