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i <br /> 4577. PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/14/2016 <br /> Permit#: C16011-053 <br /> PROJECT ADDRESS: 3y14 I 31ST DR �2 <br /> DESCRIPTION OF WORK: NEW TOWNHOME LOT I'I,,BLDG 15 <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: POLYGON WLH LLC <br /> ADDRESS: 11624 SE 5TH ST SUITE 100 ADDRESS: 11624 SE 5TH ST SUITE 100 <br /> BELLEVUE,WA, 98005 BELLEVUE,WA,98005 <br /> PHONE: 4255867700 PHONE: 4255867700 <br /> EMAIL: EMAIL: <br /> CONTACT: ❑ Owner ❑ 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? P( YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: 6/0/8W--02 <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 /> lit NO <br /> Explanation: AM, COAL <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> RYES—Amount$ 500.0- 0 3 i1 YES—Amount$ <br /> S Meter Only, 0 Complete Service, Size /� 0 3/" Detect Meter Only, 0 Fire Service Size <br /> ❑ NO FINO <br /> Explanation: Explanation: <br /> N1�IftI RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> Al 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 /> 181,YES—Amount$ 70s d0 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> YES—Amount$ 0 See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: 1163 til lawnhterng. &dersPiAird) <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ ❑ See Attached Spreadsheet <br /> KNO Afruz1,3 pea in-pal <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKIT Print Menu and include) <br /> 1�YES—TYPE 7VWNHemI6 See Attached Letter x ISCOJ'L OMk JE ffir£y marks <br /> ❑ NO `©n& abtady anodize! lo ,(N permit-leo <br /> 11(13/ <br /> PW Reviewer: / / Date: <br /> agwitiR...- 382018 <br /> REVISED 10/11/2016 <br />