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• 4E77 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/18/2017 <br /> Permit#: PW1708- O/S <br /> PROJECT ADDRESS: 1702 31ST AVE SE C o7` .73 <br /> DESCRIPTION OF WORK: SITE WORK FOR A NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PANT 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?,, YES 0 NO_ W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C / 707 —03O <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 /> %NO <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: o a FIRE SERVICE: <br /> ❑YES–Amount$ –T80�` 3 0 YES–Amount$ <br /> 'Meter Only, 0 Complete Service, Size 0%"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO XNO <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 /> 00 <br /> EYES–Amount$ 70 , New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 2 7 244 <br /> AYES–Amount$ 117 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? (7 <br /> ❑YES–Amount$ O� 0 See Attached Spreadsheet <br /> ' NO Pa!G✓Qfe'td: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> OYES–TYPE S A"X' x'See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> gr4 7-/l/7 <br /> REVISED 10/11/2016 <br />