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C4". PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/2/2017 <br /> q Permit#: PW1710•Z/' <br /> PROJECT ADDRESS: 3OQ'/ <br /> 00,6 34TH PL L <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW TOWNHOIVIE <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?AYES 0 NO W.O.#: f / <br /> Notes: Associated Bldg./PW Permit#: C/r 606 — /0__ <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 /> ,NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: 7 0 to FIRE SERVICE: <br /> ❑YES—Amount$ 0 YES—Amount$ <br /> %Meter Only, 0 Complete Service, Size 0 3/4"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO NO <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$ 7©"-' Xi Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? /1/3 T <br /> .&YES—Amount$ 8796, 0 See Attached Spreadsheet <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$ T� �❑//See Attached Spreadsheet <br /> "(NO Pati Cl`/ J( <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address),print out Address Letter from TRAKiT Print Menu and include) <br /> OYES—TYPE S"1'l� Mee Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> kirlk Vg—/ <br /> REVISED 10/11/2016 <br />