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04n- PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/22/2018 <br /> Permit#: PW1802-03q <br /> PROJECT ADDRESS: 1/3// ?obi Dr SE (LOT 154) <br /> DESCRIPTION OF WORK: SITE WORK AND TRAFFIC MITIGATION FOR NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: POLYGON WLH LLC <br /> ADDRESS: 11624 SE 5TH ST SUITE 100 ADDRESS: 11624 SE 5TH ST SUITE 100 <br /> BELLEVUE,WA,98005 BELLEVUE,WA,98005 <br /> PHONE: 4255867700 PHONE: 4255867700 <br /> EMAIL: jamie.aubrey@gmail.com EMAIL: jamie.aubrey@gmail.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? YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C/SU/— 0/0 <br /> - <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 /> V 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 /> 'YES—Amount$ 5©0. d ❑YES—Amount$ <br /> 'Meter Only, 0 Complete Service,Size "//�l 0 3/"Detect Meter Only, 0 Fire Service Size <br /> 0 N 14NO <br /> Explanation: Explanation: <br /> hilk3 RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> NIkEl 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 /> CAYES—Amount$ %° a New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> E[YES—Amount$ /l 9$y, °O 0 See Attached Spreadsheet <br /> ❑ NO—No Change of the/Other P "� <br /> Explanation: 20 V,3T /1j SPA -- (uaatc if aeiver --).add fa bld9 PErmtt <br /> (Note:P lic Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAF C MITIGATIO EE? <br /> Si Y S—Amount$ 35 0 See Attached Spreadsheet <br /> ADDRESS LETTER REQUIRED? (If yes (new assigne�s), Arint out Address Letter from TRAKiT Print Menu and include) <br /> EYES—TYPE SF/Z- $E'SeeAttached Letter>c2. —sae" 6) 1v JE �n , <br /> CI v' I <br /> PW Reviewer: Date: /zzze8, <br /> ....)A, <br /> REVISED 10/11/2016 <br />