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0$"7PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/24/2017 <br /> Permit#: PW1703-055 <br /> PROJECT ADDRESS: 3409 31ST DR LOT162 <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW TOWNHOME/TRAFFIC MITIGATION <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PNW Riverfront LLC <br /> ADDRESS: 11624 SE 5TH ST ADDRESS: 11624 SE 5th Street#200 <br /> BELLEVUE,WA, 98005 BELLEVUE,WA, 98005 <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: nicka@polygonhomes.com <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? 0 YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C/60 3—c 46 <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ❑YES—Type (If yes,add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> 49 NO <br /> Explanation: <br /> (Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: / FIRE SERVICE: <br /> ID YES—Amount$ 4 ,o 'N fIS ❑YES—Amount$ <br /> I Meter Only, 0 Complete Service, Size /i 0 3/4' Detect Meter Only, 0 Fire Service Size <br /> 0 N 117 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 /> YES—Amount$ 1 "til 54 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 5511(04° <br /> YES—Amount$ )_ 0 See Attached Spreadsheet S <br /> ❑ NO—No Change of Use/Other tlCt(00 <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> YES—Amount$ 3 S—I' h'c 0 See Attached Spreadsheet � ' L_ elP <br /> El NO /4/!. � tilt t r`- <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ISIYES—TYPE -S%/2 0 See Attached Letter <br /> ❑ NO <br /> PW Reviewer: r�V 41341 te �'r��4)Yo S Date: O 571 <br /> REVISED 10/11/2016 <br />