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4477PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/11/2017 <br /> Permit#: PW1704-014 <br /> • <br /> PROJECT ADDRESS: 3404 31st Dr LOT 107 <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: 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?RYES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C�/0.04 <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 /> M NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: pO FIRE SERVICE: <br /> }BYES–Amount$ ��0 — 0 YES–Amount$ <br /> 1 Meter Only, 0 Complete Service, Size A 0%"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO N'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-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? Od <br /> 7 <br /> EYES–Amount$ /0 ) "New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> %YES–Amount$ 62 7 96 0 See Attached Spreadsheet hied Size LiO(l.Se <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? oo <br /> %YES–Amount$ 357 0 See Attached Spreadsheet <br /> ❑ NO <br /> See %kt bf–/C4 en4Q%L <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> OYES–TYPE S, /rC XSee Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: 4 /` -/ 7 <br /> REVISED 10/11/2016 <br />