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/1.1d7-4PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/20/2016 <br /> Permit#: PW1609-077 <br /> PROJECT ADDRESS: 3019 44TH ST SE <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR BASIC/2015 IRC-RB1502-005-LOT 63 <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: POLYGON WLH LLC <br /> ADDRESS: 11624 SE 5TH ST SUITE 100 ADDRESS: 11624 SE 5TH ST SUITE 100 <br /> BELLEVUE,WA, 98005 BELLEVUE,WA,98005 <br /> PHONE: 4255867700 PHONE: 4255867700 <br /> EMAIL: jamie.aubrey@gmail.com EMAIL: jamie.aubrey@gmail.com <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM n qq ��}�rr�� <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: SOB ILI—VVI, <br /> PW Permit Required?igf YES 0 NO W.O.#: ,, 0 <br /> Notes: 'i,Associated Bldg./PW Permit#: 6'O4 <br /> 1 —01 L1 <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 /> ArNO <br /> Explanation: c6 <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> EYES—Amount$ 930./t°' 11 ❑YES—Amount$ <br /> DirMeter Only, 0 Complete Service, Size 3 �I 0 3/4"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO W(1\10 <br /> Explanation: Explanation: <br /> ❑Water Department Cost Estimate Needed-(lf 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$ r KNew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> )(YES—Amount$ 9 f/O.21? 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$_53$ eA_ y�, I 0 See Attached Sprpadsheet <br /> ❑ NO Irl - B Onto( ( 4—U—�6) <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> DYES—TYPE Ste- IgSee Attached Letter <br /> 0N o <br /> Public Works Reviewer Signature - Date <br /> REVISED 2/24/2016 <br />