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4"7PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/22/2018 <br /> Permit#: PW1802-0$S <br /> PROJECT ADDRESS: 43/3 'O1 Dr sE (LOT 1S5) <br /> DESCRIPTION OF WORK: SITE WORK AND TRAFFIC MITIGATION FOR NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: POLYGON WLH LLC <br /> ADDRESS: 11624 SE 5TH ST SUITE 100 ADDRESS: 11624 SE 5TH ST SUITE 100 <br /> BELLEVUE,WA, 98005 BELLEVUE,WA,98005 <br /> PHONE: 4255867700 PHONE: 4255867700 <br /> EMAIL: jamie.aubrey@gmail.com EMAIL: jamie.aubrey@gmail.com <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?1StYES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: C,/RO/--Oa <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ❑YES—Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> 'YES—Amount$ 560• / �I ❑YES—Amount$ <br /> El Only, Complete Service, Size *Y 03/4"Detect Meter Only, ❑ Fire Service Size <br /> El NO 14NO <br /> Explanation: Explanation: <br /> I11 l RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> NISI 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 /> YES—Amount$ % EL New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> »YES—Amount$ // 9$y, °0 ❑ See Attached Spreadsheet <br /> ID NO—No Change of Use 28 <br /> /Other L <br /> Explanation: !,5 8-/ /JEW SFA -• `GudSF • Er 4 c3&fit1£r - dJ fa bid? P6'mt'f <br /> (Note:Pu.is Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFF MITIGATION FEE? <br /> QTS—Amount$ $g7, " 0 See Attached Spreadsheet <br /> • • 4 on i%t) ftrm}F ,,j <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned addre s), rint out Address Letter from TRAKiT Print Menu and include) <br /> '(YES—TYPE SFr- lo'SeeAttached LetterX2 —seat 6) iv Jrn� <br /> El NO <br /> (/ <br /> PW Reviewer: ' Date: /z2zehs„ <br /> v <br /> REVISED 10/11/2016 <br />