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0477 a <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/2/2017 <br /> Permit#: PW1710,O/4-- <br /> PROJECT ADDRESS: a30/C' 34TH PL L07`2/ <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?AYES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C/606 "h93 <br /> FIRE SPRINKLER REQUIRED?(bv Fire Department/Code) <br /> 0 YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> liff NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit.'or any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: �rjQ FIRE SERVICE: <br /> ❑YES—Amount$ ®� 0 YES—Amount$ <br /> Meter Only, 0 Complete Service, Size; 0%" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO A`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 Neede d-(If yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> , 0p <br /> YES—Amount$ 70— K New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? j,38/ <br /> YES—Amount$ eF796, C 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 /> )(NO Paic/ Q(t ( <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> * YES—TYPE Sl� 'See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> el./1 /4-/2-/7 <br /> REVISED 10/11/2016 <br />