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■ii <br /> OjerrPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 'I SITE PLAN FOR REVIEW) Date: 6/20/2017 <br /> Permit#: /706 -oz. . <br /> PROJECT ADDRESS:34 /3 T 30TH DR LOT <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW TOWNHOME <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 /60 /2Q <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 /> ANO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? �[� <br /> DOMESTIC SERVICE: rl god FIRE SERVICE: <br /> ❑YES-Amount$ 480 // ❑YES-Amount$ <br /> ,('Meter Only, 0 Complete Service,Size 74 ❑%"Detect Meter Only, 0 Fire Service Size <br /> ❑NO ,i(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? ®O <br /> ❑ NOEYES <br /> -Amount$ 70— ANew Connection, 0 Alteration/Repair, ❑ Cap-off/Reconnect <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 13 2 -,1j <br /> )(YES-Amount$ 579, 0 See Attached Spreadsheet / J <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$ 0 See Attached Spreadsheet <br /> .i NO ./96/-e4&f9.4);i . <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> Ar YES-TYPE Sic-A" ,'See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: 6-20-/7 <br /> REVISED 10/11/2016 <br />