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• <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/1/2017 <br /> Permit#: PW1708- 04 <br /> PROJECT ADDRESS: . 1 ,02 _2(841 e,s Lo'f4 <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: PANT 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 /708-- 013 3 . <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 /> X,O <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) • <br /> WATER FEES? <br /> DOMESTIC SERVICE: p O FIRE SERVICE: ' <br /> ❑YES—Amount$ <br /> ,98' 0 YES—Amount$ <br /> Meter Only, 0 Complete Service,Size 0 W Detect Meter Only, 0 Fire Service Size <br /> CI NO 0N <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? 00 <br /> RYES—Amount$ 77 "New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0 NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 2353 <br /> ,'YES—Amount$ /j)/94 7 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 /> r❑�YES—Amount$ 0 See Attached Spreadsheet <br /> XNO <br /> Paid <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address),print out Address Letter from TRAKiT Print Menu and include) <br /> MI"YES—TYPE - 'F *See Attached Letter <br /> 0N <br /> PW Reviewer: Date: <br /> 2-.23- 17 <br /> REVISED 10/11/2016 <br />