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04". PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/20/2017 <br /> Permit#: PW1707-633 <br /> PROJECT ADDRESS: g507 30TH DR SE L 74. 4.7 <br /> DESCRIPTION OF WORK: SITE WORK FOR A NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PANI ALAN I 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?RYES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#:C /704 _O 2 <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 /> )1(NO <br /> Explanation: • <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: 12-1:2- 34 <br /> FIRE SERVICE: <br /> ❑YES—Amount$ 180 tj 3/ ❑YES—Amount$ <br /> ,1 'Meter Only, 0 Complete Service,Size ❑%"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? ao <br /> EYES—Amount$ 7D _New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? ZOO 2.45 <br /> ,(YES—Amount$_/Q 917 , 0 See Attached Spreadsheet <br /> ❑NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> iitpo PQ;C! Q&Patcly <br /> ADDRESS LETTER REQUIRED? (If ye (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> %YES—TYPE S FI ' %See Attached Letter <br /> ❑ NO <br /> PW Reviewer:..___ Date: <br /> 7-2o-/ <br /> REVISED 10/11/2016 <br />