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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/18/2017 <br /> Permit#: PW1708-008 <br /> PROJECT ADDRESS: 4422 29TH AVE SE LA-f-ft g <br /> DESCRIPTION OF WORK: SITE WORK FOR A NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PANI ALAN/POLYGON <br /> ADDRESS: 4695 MACARTHUR CT 8TH FLR ADDRESS: <br /> NEWPORT BEACH,CA, 92660 , <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: <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?AYES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C /7o 7 CCS/ <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 /> XNO <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: //�� pQ FIRE SERVICE: <br /> ❑YES—Amount$ `75d , //'�/ 0 YES—Amount$ <br /> ,'Meter Only, 0 Complete Service, Size /4- ❑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? <br /> `YES—Amount$ 7e,p Altlew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> CI NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> ��� <br /> )$'YES—Amount$ /t f947 0 See Attached Spreadsheet <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 /> WNO Paeld;r! ALL ,E�!^c.1/C©U:1 <br /> ADDRESS LETTER REQUIRED? (If yes/(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> / YES—TYPE ‘,5-.47/C. 0 See Attached Letter <br /> ❑ NO <br /> PW Reviewer: k:4Date: � /7'"� <br /> REVISED 10/11/2016 <br />