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0147T PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 6/12/2017 <br /> Permit#: PW1706- e62. <br /> PROJECT ADDRESS: 342S 30th Dr LOT 5 9 <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW TOWNHOME <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?Igt YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C /606 -o8 <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: ou FIRE SERVICE: <br /> LI YES–Amount$ "ISO— ❑YES–Amount$ <br /> Meter Only, 0 Complete Service,Size ."4- ❑%"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO ANO <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 /> 0 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? �d <br /> E YES–Amount$ 7a— *New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0 N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <'3 9 <br /> ,14 YES–Amount$ E37 9/ 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$ O- 0 See Attached Spreadsheet <br /> 74 NO GLreaEty pcdd <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> X(YES–TYPE S Pg X'See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> –ZCI -( 7 <br /> REVISED 10/11/2016 <br />