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477 <br /> PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/14/2017 <br /> Permit#: PW1708- 06 Z <br /> PROJECT ADDRESS: 45.'/3 31ST AVE SE L d1-- <br /> DESCRIPTION OF WORK: SITE WORK 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?,YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: /708— .0 /4 <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 /> %NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: QO FIRE SERVICE: <br /> ❑YES–Amount$ 480192- 0 YES–Amount$ <br /> ,Meter Only, 0 Complete Service,Size ❑3/<"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO ,1NO <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 /> 00 <br /> "igES–Amount$ 7D-— New Connection, ❑Alteration/Repair, El Cap-off/Reconnect <br /> NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> %YES-Amount$ /`L7 ?¢7 0 See Attached Spreadsheet 2 /-7 <br /> 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 /> ❑YES–Amount$ 0 See Attached Spreadsheet <br /> NO <br /> Paid for ?ia.# area <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> EYES–TYPE SFR , See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> ��!rin <br /> 90J17 <br /> REVISED 10/11/2016 <br />