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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 2/22/2018 <br /> Permit#: PW1802-03 - <br /> PROJECT ADDRESS: 14314- 30 Dr SE (LOT/5 ) <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: ❑ 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? YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: CJRO/-0f3 <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 /> NT 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$ 5OC• / j1 ❑YES—Amount$ <br /> � <br /> 'Meter Only, 0 Complete Service, Size y 0 3/"Detect Meter Only, 0 Fire Service Size <br /> CI NO 14NO <br /> Explanation: Explanation: <br /> ?JJ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> WPM 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 /> BYES—Amount$ t 22.New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> Er YES—Amount$ /I 9 ' l. 0 See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: 2S1S S-F tJEUJ SPA. -'i ovakr sewer Gadd ¢a bid? e mtt <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> RAFFIC MITIGAT •N FEE? <br /> YES—A •unt i. 0.Adilk 0 See 0 — Attac ed Spreadsheet <br /> on > I' I / " Q�IG�/' <br /> ADD- = LETTER REQUIRED? (If yes (new assigned address), *lint dut Address Letter from TRAKiT Print Menu and include) <br /> 'EYES—TYPE SF/Z- QR'SeeAttached LetterX2 —Sa. 6) -fa JE I rzy �f . <br /> ❑ NO (/ �f <br /> PW Reviewer: s Date: 2/a/us <br /> REVISED 10/11/2016 <br />