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• <br /> 46-n- PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 6/26/2017 <br /> Permit#: PW1707-6/4_ <br /> PROJECT ADDRESS: 3432 31th Dr LOT /lc <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: PANT ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?,t1 YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#:C/6 0 ©%l <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 /> ,l'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 /> @� <br /> ❑YES—Amount$ 480 3 0 YES—Amount$ <br /> , Meter Only, 0 Complete Service,Size 4 0'/a"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO .1 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-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? --7 p0 <br /> X YES—Amount$ /0. *New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? J7I� <br /> 'YES—Amount$ 8757, 0 See Attached Spreadsheet /51'8 `t' <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? p <br /> ❑YES—Amount$ a� 0 See Attached Spreadsheet <br /> NiNOo9eQc�_ 4!of <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,I YES—TYPE ..SA-A" .$TSee Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> 710-i7 <br /> REVISED 10/11/2016 <br />