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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 6/14/2016 <br /> Permit#: PW1606-018 <br /> PROJECT ADDRESS: 4309 29TH DR SE LOT 102 <br /> DESCRIPTION OF WORK: NEW SFR BASIC-PLAN#2645 A <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: [AppName] <br /> ADDRESS: 4695 MACARTHUR CT 8TH FLR ADDRESS: [AppAdd] <br /> NEWPORT BEACH, CA, 92660 [AppCi], [AppSt], [AppZip] <br /> PHONE: PHONE: [AppPhone] <br /> EMAIL: EMAIL: [AppEmail] <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?El YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C160.6 —8 498 <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ! 0 YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> tit NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: po FIRE SERVICE: <br /> ❑YES—Amount$ <br /> Ad, <br /> 3j�i ❑YES—Amount$ <br /> ,Meter Only, ❑ Complete Service, Size 4 ❑%" Detect Meter Only, 0 Fire Service Size <br /> 0 N NO <br /> Explanation: Explanation: <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? $ pb <br /> Al YES—Amount$ 701L-5 0 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? spZr <br /> .131 YES—Amount$ 0 See Attached Spreadsheet /9/07/,rQV,1 CA) w/ <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 /> EYES—Amount$ 700 0 See Attached Spreadsheet <br /> ❑ NO �`^ /14!Ie 8r'GICC 6 4116 <br /> 6 <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ,Qf YES—TYPE SFX. ,(See Attached Letter <br /> 0 N <br /> (44‘-zer,,Lr____. 6- <br /> Public Works Revie er Signature Date <br /> REVISED 2/24/2016 <br />