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4"7" PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/20/2017 <br /> Permit#: PW1710-032 <br /> PROJECT ADDRESS: 10627 19TH AVE SE <br /> DESCRIPTION OF WORK: CONSTRUCT COMMERCIAL BLDG (DENTAL OFFICE) <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: EPC HOLDINGS 908 LLC NAME: GABBERT ARCHITECTS <br /> ADDRESS: 2001 WESTERN AVE SUITE 330 ADDRESS: 20011 BALLINGER WAY NE <br /> SEATTLE,WA,98121 SHORELINE,WA,98155 <br /> PHONE: PHONE: 063673600 <br /> EMAIL: EMAIL: simon.s@gabbertarchitects.com <br /> CONTACT: 0 Owner 0 Applicant DOther <br /> NAME: SIMON SIMON GABBERT ARCHITECTS <br /> PHONE: 063673600 <br /> EMAIL: simon.s@gabbertarchitects.com <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?It YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: B/7/o-03? <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 /> *NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: pQ FIRE SERVICE: <br /> YES-Amount$ Z ' 2 // ❑YES-Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0%" Detect Meter Only, 0 Fire Service Size <br /> Explanation:❑ {ALSO/ .�rrrr ServIC� 29©0t2 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? 00 <br /> ,h1YES-Amount$ (1 — )(New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 2/ to¢h dist ---Z1r20�X /� 2i 662 ,80 <br /> 'YES-Amount$ 2 4 27 ❑ See Attached Spreadsheet RAIL-,re office,--W cl(o 1.7 X _ 70(?_ 2 7 7 7 4J <br /> o NO-No Change of Use --/Other <br /> x° 2342721 <br /> Explanation: / <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? OD <br /> ,WYES-Amount$ 3 8(A'1 , See Attached Spreadsheet <br /> 0 N ej-narL 4-0 Irv) yii2k.e //-7-17 <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out ddress Letter from TRAKi Print Mien d include <br /> .YES-TYPE C 7tr? l,A See Attached Letter Ed /�,l / (Gi4nrry <br /> ❑ NO '-gC.dl.n 2_ /'1at'ffr <br /> PW Reviewer: Date: <br /> rtc IZ--c 17 <br /> REVISED 10/11/2016 <br />