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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/3/2017 <br /> Permit#: PW1707-%%a <br /> PROJECT ADDRESS: 34/7 31th Dr LOT 15 <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW TOWNHOME <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PNW Riverfront LLC <br /> ADDRESS: 11624 SE 5TH ST ADDRESS: 11624 SE 5th Street#200 <br /> BELLEVUE,WA, 98005 BELLEVUE,WA,98005 <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: nicka@polygonhomes.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?'YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: G /604— 0.12. <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 /> ,VNO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: 00 FIRE SERVICE: <br /> ❑YES—Amount$ ��©� 3� 0 YES—Amount$ <br /> , 'Meter Only, 0 Complete Service,Size 4/ ❑3/"Detect Meter Only, ❑Fire Service Size <br /> ❑ NO ANO <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? pp <br /> >�YES—Amount$ 709_ '<New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0 N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? /38 / JJ <br /> ❑YES—Amount$ g774, 0 See Attached Spreadsheet I <br /> ❑NO—No Change of Use I 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 Pa;Of CO-0276r <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> RYES—TYPE QS`FiC , See Attached Letter <br /> 0 N <br /> PW Reviewer: <br /> k:,;(4 <br /> Date: <br /> REVISED W/11/2016 <br />