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0477 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/1/2017 <br /> Permit#: PW1703-OOZ_ <br /> PROJECT ADDRESS: 3461 +30th Dr LOT 6dit <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 ❑ Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: C /b44— //4 <br /> PW Permit Required? II 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 /> [KNO <br /> xplanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: h FIRE SERVICE: <br /> ❑YES—Amount$ 4 S(9 eVIA �/ 0 YES—Amount$ <br /> Meter Only, ❑Complete Service, Size ❑%"Detect Meter Only, 0 Fire Service Size <br /> CIlJO et 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 /> 0 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? y IX-New <br /> tf4 YES—Amount$ / New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> Ar'YES—Amount$ fI 4-q;. 0 See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewe to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FE .i <br /> g YE —Amount$ 3 II C r ❑ See Attached Spreadsheet fr??, Z.;41- <br /> ¢41-uxl.0 R. E. <br /> / -OA <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> IOfYES—TYPE S7-/2 0 See Attached Letter <br /> ❑ NO <br /> PW Reviewer: ‘7,744.7w Date: 7/ <br /> REVISED 10/11/2016 <br />