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477PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/21/2017 <br /> Permit#: ' PW1709,OIs' <br /> PROJECT ADDRESS: 34 47 30TH DR Zed. 4 9 <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: 0 Owner ❑ 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?V YES 0 NO W.O.#: f �3 <br /> Notes: Associated Bldg./PW Permit#: C./6O —�8ii <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 /> • <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: Oe FIRE SERVICE: <br /> ❑YES–Amount$ 180 — 3 0 YES–Amount$ <br /> )(Meter Only, 0 Complete Service,Size 3/4"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? 40 <br /> , 'ES–Amount$ 7D - )(New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? /33 Z T <br /> 'ES–Amount$ 7,6 0 See Attached Spreadsheet <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 /> /"�NO P4/C/1 Qtr'2 4b <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> , YES–TYPE .5-40 /c ,,kSee Attached Letter <br /> 0N <br /> PW Reviewer: V Date: Y,- 7_17 <br /> kr` <br /> REVISED 10/11/2016 <br />