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04.77- PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/3/2017 <br /> Permit#: PW1707-946- <br /> PROJECT ADDRESS: 3444 31th Dr LOT 120 QSO <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#: `_r <br /> /6o1 " C �� <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 /> ''NO <br /> Explanation: - <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: //����1, FIRE SERVICE: <br /> El YES—Amount$ `TC�D�'o�J 3/ <br /> 0 YES—Amount$ <br /> Meter Only, ❑Complete Service, Size �L� ❑3/"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO ONO <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? -7,006 <br /> ,INrYES—Amount$ / 0 New Connection, 0 Alteration/Repair, ❑ Cap-off/Reconnect <br /> LI NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> J 'ES—Amount$ 8737,6 0 See Attached Spreadsheet f344- <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> • <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 /> -rNO //� <br /> �Q%cr620^Caly <br /> ADDRESS LETTER REQUIRED? (f yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> A AYES—TYPE cS ori Ai See Attached Letter <br /> El NO <br /> PW Reviewer: / Date: <br /> REVISED 10/11/2016 -f <br />