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4ErrPUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 3/15/2018 <br /> Permit#: B1803-026 <br /> PROJECT ADDRESS: 11419 19TH AVE SE UNIT C <br /> DESCRIPTION OF WORK: TI -ACUPUNTURE CLINIC-INSTALL WALLS <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: SILVER LAKE PLAZA(USA) NAME: [AppName] <br /> INVESTMENT INC ADDRESS: [AppAdd] <br /> ADDRESS: 12501,BEL-RED RD STE 106 [AppCi], [AppSt], [AppZip] <br /> BELLEVUE,WA,98005 PHONE: [AppPhone] <br /> PHONE: EMAIL: [AppEmail] <br /> EMAIL: <br /> CONTACT: ❑ Owner 0 Applicant ❑Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? 0 YES 0 NO W.O.#: <br /> Notes: Associated BIdgJPW Permit#: <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 /> 0N <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑YES-Amount$ 0 YES-Amount$ <br /> 0 Meter Only, 0 Complete Service, Size 0 W Detect Meter Only, 0 Fire Service Size <br /> If(NO )1(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-Of yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> ❑YES-Amount$ 0 New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> At NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT E? <br /> $VES-Amount$_ .5 wF v6Z fifiii ?I(See Attached Spreadsheet <br /> in NO-No Change_]ofi,U,se/Other AI <br /> /'� ��� J�„„ <br /> Explanation: 1 - vL 49'62.74, , S�!'.4i��ir''` ilif i ��j'n C(/r ��% i <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) ff <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES-Amount$"" ���� ((' �0+ Se Attached Spreadsheet <br /> $�NO 9 j�'Ia t,(-t&Jd he �TFic JC(,.. <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES-TYPE 0 See Attached Letter <br /> ifirNO / <br /> PW Reviewer: Date: LI/Sjidmitik, <br /> //S <br /> REVISED 10/11/2016 [[[ <br />