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PUBLIC WORKS <br /> 477 <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/112017 <br /> Permit#: PW1708.04" <br /> PROJECT ADDRESS: 329' 31th Dr LOT f 49 <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: 11 624 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?V,YES 0 NO W.O.#: //' Qn <br /> Notes: Associated Bldg./PW Permit#:C /6 o4--' 04.7 <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 /> ,ANO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) - <br /> WATER FEES? <br /> DOMESTIC SERVICE: A g 0 00 FIRE SERVICE: <br /> ❑YES—Amount$ 7 3 ❑YES—Amount$ <br /> fli'Meter Only, 0 Complete Service,Size �¢ 0%.Detect Meter Only, 0 Fire Service Size <br /> 0N LINO <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? --7„)C d <br /> ,$I YES—Amount$ / %New Connection, 0 Alteration/Repair, ❑ Cap-off/Reconnect <br /> 0N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? if <br /> $'YES—Amount$ S7 q tp 0 See Attached Spreadsheet 1163 <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 /> AlNO Paid a t eady 6uCk <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> OYES—TYPE FR %See Attached Letter <br /> 0N <br /> PW Reviewer: Date: <br /> �k d -ZZ -17 <br /> REVISED 10/11/2016 <br />