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04-T PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/21/2017 <br /> Permit#: PW1709•O/ /q <br /> PROJECT ADDRESS: 3437 30TH DR Lb-f L-3 <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: ❑ Owner ❑ Applicant Dottier <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: • <br /> LAND USE PROJECT#: <br /> PW Permit Required?,4 YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C./606-- Q d 7 <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: pe ' FIRE SERVICE: <br /> ❑YES–Amount$ 480 — 3 ❑YES–Amount$ <br /> Meter Only, 0 Complete Service,Size da:3/a"Detect Meter Only, 0 Fire Service Size <br /> ❑NO ANO <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-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? cC <br /> . 'YES–Amount$ 7D"' )(New Connection, ❑Alteration/Repair, ❑ Cap-off/Reconnect <br /> 0N - ` <br /> Explanation: <br /> Existing Utility.Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? /546 <br /> x'ES—Amount$ 113796 0 See Attached Spreadsheet T �f=� <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 /> XNO � eill''e et <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> RYES–TYPE S'IGf ,(See Attached Letter <br /> ❑NO <br /> PW Reviewer: Date: 9 ?��7 <br /> REVISED 10/11/2016 <br />