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PUBLIC WORKS <br /> OttErr REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4-L4 -!7 <br /> Permit#: PW17b4-O 3 <br /> PROJECT ADDRESS: 3401-30th Dr LOT.>‘k- <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: ❑ 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#:C /603-0 <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 /> ,INO <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 /> IYES-Amount$ 4/'T2 3 ❑YES-Amount$ <br /> 0 Meter Only, ❑ Complete Service, Size A' 0 3/4"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO 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? Day <br /> (TYES-Amount$ New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0 N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 07 <br /> YES-Amount: 5796 0 See Attached Spreadsheet qLL tCcf Wu Med S7 z E' <br /> ElNO-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? 0 <br /> WYES-Amount$_ t,_ 0 See Attached Spreadsheet <br /> ❑ NO <br /> ``- Per/14k2 B i GSC' eai L <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> .AYES-TYPE St"--/Z. %See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />