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I 4.- PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 5/9/2017 <br /> Permit#: B1705-014 <br /> PROJECT ADDRESS: 6502 EVERGREEN WAY <br /> DESCRIPTION OF WORK: NEW MIXED-USED RETAIL,COMM, EHANCED SRVCS <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: MADISON REAL PROPERTY LLC NAME: MADISON TODD <br /> ADDRESS: PO BOX 31609 ADDRESS: <br /> SEATTLE,WA, 98103 , , <br /> PHONE: PHONE: 2066195555 <br /> EMAIL: EMAIL: TODDMADISON@HOTMAIL.COM <br /> CONTACT: Owner 0 Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] ' <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: ggEr 17- -005 <br /> PW Permit Required?RYES 0 NO ,, ,Q W.O.#: <br /> T W <br /> Notes: ((105-0v-1 _ate 1r$S0E4• Associated Bldg./PW Permit#: etA)1405 oz <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> V 14 YES-Type (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: Ft— Q :3,E <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) 0 ILI <br /> WATER FEES? �1 <br /> DOMESTIC SERVICE: o all t?W 015 ,'FIRE SERVICE: Lid('Lid(' `� <br /> g YES-Amount$ 11:10g.®a. �� %YES-Amount$ 1.30,do <br /> 1I <br /> ❑ Meter Only, g Complete Service, Size t 3/4" Detect Meter Only, 0 Fire Service Size 11 <br /> O <br /> ❑Explanation: E❑xpla ation: IN V&Ldi- OIIIS►d <br /> I RPBA Needed at premises?-(Plumbing pe it for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> ril/ CUJ.lDE 81/1CDI <br /> 'NI Water Department Cost Estimate Need`If yes, PW Reviewe to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): (ZCOSf Es- - cm& 74r y" ST,r Conhfrl/fn�71 OIIE Y6c- fry Aiydr .Oennuirxr. <br /> t0 .SEWER FEE? i G� [an it-tric �i 7 <br /> YES-Amount$ g New Connection, 0 Alteration/Repair, 10 Cap-off/Reconnect 4� <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> / SYSTEM DEVELOPMENT FEE? <br /> EYES-Amount$ y5)O5a,66 )8(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 /> EYES-Amount$ 3,q .0 I'See Attached Spreadsheet <br /> ❑ NO <br /> V ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKT Print Menu and include) <br /> '<YES-TYPE COMM SA A1, gfSee Attached Letter(z ..-9Oitt.�-1--to JE ` Q/t& <br /> ID NO PW Reviewer: Date: <br /> atinw <br /> ii 'M 13- <br /> REVISED 10/11/2016 <br />