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477 PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/14/2017 <br /> 45'/S-3)—t Permit#: PW1708- 06 9• <br /> PROJECT ADDRESS: - 291'11 AVE SE <br /> DESCRIPTION OF WORK: SITE WORK FOR A NEW SFR• <br /> Q S <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?)4 YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#:C j/0g 034 <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 /> XNO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: 490 p FIRE SERVICE: <br /> Ill YES—Amount$ �TC�O�' 3//j ❑YES—Amount$ <br /> ,Meter Only, 0 Complete Service, Size /� 0 3/4"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO VNO <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-Of yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing.Utility Permit#(if applicable): • <br /> SEWER FEE? d p <br /> %YES—Amount$ 7d� fANew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? 2720 <br /> RYES—Amount$ /0) 947 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$ El See Attached Spreadsheet <br /> ,i'NO P *sic/ Q r a LL D. NA-t' <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> (YES—TYPE • S F le )(See Attached Letter <br /> 0 N <br /> PW Reviewer: Date: <br /> Kirk q- 1 -1 7 <br /> REVISED 10/11/2016 <br />