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4"TPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/30/2017 <br /> Permit#: PW1704. O S? <br /> PROJECT ADDRESS: 140 -51-S702 SE LOT 43 <br /> DESCRIPTION OF WORK: SITE WORK AND TRAFFIC MITIGATION FOR NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PANI ALAN/POLYGON <br /> ADDRESS: 4695 MACARTHUR CT 8TH FLR ADDRESS: <br /> NEWPORT BEACH,CA,92660 , <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: <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?El YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: K'/763 —e <br /> FIRE SPRINKLER REQUIRED? (by Fire Department/Code) <br /> O 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; On FIRE SERVICE: <br /> ❑YES—Amount$ 4D76)-- / >� 0 YES—Amount$ <br /> Eat Meter Only, 0 Complete Service, Size 4- 0 3/" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO $NO <br /> Explanation: Explanation: <br /> ❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> ❑Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? p <br /> f*YES Amount$_7.0—'' New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> 'Jg1 YES-Amount$. /0 147 0 See Attached Spreadsheet Z O?2. <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> EYES—Amount$ 85 4 0 See Attached Spreadsheet <br /> ❑ No per I/v7ikkc Bi-`14,k e'c4?l cla e.c� 4 - ? -/C <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> YES—TYPE ,IrSee Attached Letter <br /> NO <br /> PW Reviewer: C ifl,t" � Date: / f.7 <br /> REVISED 10/11/2016 ✓ �fQ <br />