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477. PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4--e4 -1 7 <br /> Permit#: PW1704-040 <br /> PROJECT ADDRESS: .61/.0-30 th Dr LOTS <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#: <br /> PW Permit Required? YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#:C /603--O56 <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 /> 1"t NO <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$ 4, T2 3 ❑YES—Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0 1/4"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? pi) <br /> AT'YES—Amount$ 7P New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? '7 <br /> AYES—Amount 8796 — 0 See Attached Spreadsheet 4LL to rCcfino A4ed,S/Z e <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Ad .Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? o�D <br /> %YES—Amount$ 0 See Attached Spreadsheet <br /> O NO <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> EYES—TYPE .S'P'/Z %See Attached Letter <br /> ❑ NO <br /> PW Reviewer: 4116' Date: <br /> 4 -24 _/ 7 <br /> REVISED 10/11/2016 <br />