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4-77- PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/20/2017 <br /> Permit#: PW1707- 03S <br /> PROJECT ADDRESS: 9509 30TH DR SE L®7t-48 <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: 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#:L /7c) '_cog <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 /> ›CNO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE; A ��j FIRE SERVICE: <br /> CI YES—Amount$ 180 3,4 ❑YES—Amount$ <br /> ,Meter Only, 0 Complete Service, Size 0 3/"Detect Meter Only, 0 Fire Service Size <br /> 0N Air NO <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? 0o <br /> EYES—Amount$ ?j}"' ,(New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 1 7770 <br /> ,I! YES—Amount$_87 9h 0 See Attached Spreadsheet <br /> ❑NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> ItnNo PQ:c1 4Lr <br /> ADDRESS LETTER REQUIRED? (If ye (new assigned address),print out Address Letter from TRAKiT Print Menu and include) <br /> ❑ NO%YES <br /> —TYPE S FR fi"See Attached Letter <br /> PW Reviewer: _.... Date: <br /> 'iir/ 7-2o-17 <br /> REVISED 10/11/2016 <br />