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0i4". PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/21/2017 <br /> Permit#: ' PW1709,of <br /> PROJECT ADDRESS: 34 IL 30TH DR Left 5D <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 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:4j YES ❑ NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C/6O,-08/^, <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: 08 FIRE SERVICE: <br /> O YES—Amount$ 480 3/ 0 YES—Amount$ <br /> Meter Only, 0 Complete Service, Size l4 g/a"Detect Meter Only, ❑ 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? <br /> x'ES—Amount$ 7a )(New Connection, ❑Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility,Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? /��1A <br /> ilit"Y —Amount$ €137,6 0 See Attached Spreadsheet -45- <br /> ❑ NO—No Change of Use I 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 Paid r'eQ.511 <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> )(YES—TYPE .S/c/ ,kSee Attached Letter <br /> ❑NO <br /> PW Reviewer: Date: 9 f` <br /> / <br /> krr � <br /> REVISED 10/11/2016 <br />