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477 <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/24/2017 <br /> Permit#: PW1703-054 <br /> PROJECT ADDRESS: 3407 31ST DR LOT 161 <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW TOWNHOME/TRAFFIC MITIGATION <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? 0 YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C I60 3 — 0 31 <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 /> I,fNO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: ,E� FIRE SERVICE: <br /> ❑YES-Amount$ '¢ o /f 1/ 0 YES-Amount$ <br /> Il Meter •Only, ❑ Complete Service, Size 3� 0 3/4" Detect Meter Only, 0 Fire Service Size <br /> 0 N Cil 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? <br /> la YES-Amount$ xYz 6 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> 'YES-Amount$ $ 9-R6 "g'/'/ 0 See Attached Spreadsheet S , /-' <br /> ❑ NO-No Change of use/Other t ,Y I <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> of YES-Amount$ 3 SI r��r1 0 See Attached Spreadsheet 11 ' g ( ,Qiyy.�A" <br /> 0 N r-t"- /�/ <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ! YES-TYPE ir"-- ❑ See Attached Letter <br /> ❑ NO ../1- 4)4,/,44,1(f.., <br /> PW Reviewer: Es4 Q_ - Date: ID 41 s <br /> REVISED 10/11/2016 <br />