7605 BEVERLY BLVD BEVERLY PIZZA 2022-01-21

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT # 4V1 L V� BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size Garage/Accessory Struct. Size Number of Stories Basement ❑No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: ❑Update Existing ❑New System El Not Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Add'I RCW 64.55 docs required prior to final? ❑Yes ❑ No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: u FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers ❑Fire Alarm ❑Other: Additional Notes: Fire Dept. Fees: ❑ Review of As -Built Plans - NO FIRE FEE ❑ Minimal or No Fire Scope - NO FIRE FEE !J,{ Review / Inspection S ope - ADD FIRE FEE Approved By: Date: Z V ( / ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: Date: Intake Comments: Assign To: ❑ Attach to Project No. ❑ Route to Historic Reviewer ❑ OK to Route to Other Departments ❑ Hold in Planning File Drawer Zone Overlay/Agreement Nonresidential Use Residential Use Proposed No. of Dwe ing Units: Total No. of Dwelli g Units: Planning/Land ape Inspection Required before Final? ❑Yes ❑No "In Lieu" Fee: ype: Amount $ School Im ct Fee: Total $ Calcula d: Credit: ❑Ev rett School Dist ❑Mukilteo School Dist Additional Notes: ft 4 Approved By: Date: PUBLIC WORKS Intake OK by: Date: •----------------------------------------- Intake Comments: ; PW Worksheet Needed if., ❑Sys Dev Eval ❑Traffic Mit Eva[ ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: (dental, medical, animals, mortuary, hospital, ,supportive housing) ----------------------------------------- El Route this folder for PW Review at end --- PW Review Worksheet ❑This project also has a separate concurrent PW Review (Green Folder) AND ❑Create Green Folder [Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works ❑ See PW Review worksheet and associated attached items ❑ A Separate PW Permit is Required (Permit #: PW ) AND ❑ Is located in this folder ❑ Is in a Separate Green Folder Goin with this folder for permit issuance) ❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) ❑ Public Works has no scope -- PW Not Required Additional Notes: G'µE cq� 5a'St- Vy.t Nor 7Z�61v�Ri Approved By: Date: t_