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PUBLIC WORKS <br /> /1!� REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 8/21/2017 <br /> Permit#: PW1709•fj/ <br /> PROJECT ADDRESS: 300735TH ST tor 2 5 <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: PANT 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#: C/601 1165 <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 /> X NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: C� FIRE SERVICE: <br /> ❑YES—Amount$ �� j ❑YES—Amount$ <br /> ,Meter Only, 0 Complete Service, Size /4 ❑3/" Detect Meter Only, ❑Fire Service Size <br /> ❑ NO NO <br /> Explanation: planation: <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? II 4 <br /> , YES—Amount$ 10 , lew Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0 N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? ` // <br /> 1 'ES—Amount$ /57737/57737/5773710 ❑ See Attached Spreadsheet ! / 63 40 <br /> ❑ NO—No Change of Use I 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 /> ADDRESS LETTER REQUIRED? (If yes (new ass ed address), print out Address Letter from TRAKiT Print Menu and include) <br /> aS <br /> YES—TYPE '/J&' `See Attached Letter <br /> NO <br /> PW Reviewer: Date: <br /> irk 9 - ��` <br /> REVISED 10/11/2016 <br />