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4ffirPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4/14/2016 <br /> Permit#: C16Q4-055 <br /> PROJECT ADDRESS: 311115 31ST DR <br /> DESCRIPTION OF WORK: NEW TOWNHOME LOT I'15 BLDG 'r5 <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? YES 0 NO W.O.#: p <br /> Notes: Associated Bldg./PW Permit#: 601803-023 <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 /> i(NO <br /> Explanation: AM, <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> 'EYES—Amount$ 500.°!0 3/ d 1:1 YES—Amount$ <br /> titt El Only, Complete Service, Size 41 ID 3/4" Detect Meter Only, ❑ Fire Service Size <br /> ❑ NO IN NO <br /> Explanation: Explanation: <br /> NII RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> NI[9 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 /> EYES—Amount$ .7o.°r' KNew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> Itt YES-Amount$ 0 See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: 1960 4i lwhom&- (wa ,- .9 &a) <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 Atrutztj <br /> fkrzi !4 pal <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKIT Print Menu and include) <br /> 1$[YES—TYPE -MAY-form I�See Attached Letter of cSeO.rl. CMM -10 J,f 1 y 'lar c <br /> ❑ NO `•©nE, a,Q.r -'''cam 10 PIO permit-40ot 0015y <br /> PW Reviewer: / / / Date: <br /> 2A, / S PL, .3 82818 <br /> REVISED 10/11/2016 <br />