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047TPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4--z4 -17 <br /> Permit#: PW1704--04a <br /> PROJECT ADDRESS: 3406 —30th Dr LOT 3 <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW TOWNHOME I 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 ❑ 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 /603-05'Z. <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 /> AtNiJ <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$ 4go 3 El YES–Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0 3/"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? VD <br /> "YES–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? 490 <br /> YES–Amount: 8796 0 See Attached Spreadsheet 4 LL iu dCcffi Med`,Se Z e <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$ 05Y-- See Attached Spreadsheet <br /> ❑ NO k- Per/147ke Bhr c�' P m a t! <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,DYES–TYPE ST/z ArSee Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> REVISED 10/11/2016 <br />