4522 EVERGREEN WAY STATE FARM INSURANCE 2019-09-05

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# t\S '6n BUILDING PLANNING \ Intake OK by: A. Date:deTWIDfS Intake OK by:C Date: <V-{ lci Intake Comments: Intake Comments: Assign To:1= \ILI-ei-d OA cA I-7-0 aRoute to Commercial Building 0 Attach to Project No. O Route to Residential Building ,❑ Routeerto Historic Reviewer I9 ❑ Make this a"W"Permit OK to Route to Other Departments IA Bldg Addn/Rem Size 2412.4-- 41,-9- a HOId in Planning File Drawer MA 1,4%, n' n'i' ' /v I^ ,' Garage/Accessory Struct. Size — Zone E 1 Number of Stories Overlay/Agreement Basement ZiNo ❑Yes, Fin/Unfin Nonresidential Use Q . Le_ V.S.--e_. Type of Construction V 'FResidential Use Occupancy Group 6 Proposed No. of Dwelling Units: --- Occupancy Load Total No. of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes IFINo Reason Sprinklers Required: aMts. e,s fart 6 "In Lieu" Fee:Type: Amount$ Fire Alarm: ❑Update Existing El New System ANot Req'd School Impact Fee: Total $ Reason Fire Alarm Required: e-- - 42— Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes Jai No DEverett School Dist ❑Mlukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes gNo Additional Notes: VALUATION CALCULATION: Total $ '°, poo Approved B � Date: c12,74 `S' PUBLIC WORKS Intake OK by:. ;* Date: /yf8' Additional Notes: Intake Comments: /3 sF PW Worksheet Needed if: Qj 't kowc,,r Sk �p .1zR5ys Dev Eval Traffic Mit Eval ,� /j Site Work or Drainage Proposed Date: O kie--l nSW51160- b) ❑Backflow Prevention for high hazard: Approved By: `� �-- l8 S net dernE bc,li hl, (dental,medical,animals,mortuary,hospital, silt L supportive housing) FIRE DEPARTMENT Route �this folder for PWReview atend -- PW Review Worksheet Intake: (Needed for Townhomes,Alley load SFR,New Commercial) DThis project also has a separate concurrent PW Review(Green Folder) ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works Date: (OK to Route to Other Departments) See PW Review Worksheet and associated attached items Fire Sprinklers: ❑Update Existing ❑New System Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) Fire Alarm: ❑Update Existing ❑New System L'It Req'd AND 0 Is located in this folder Chemical Sup: ❑Update Existing ❑New System Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) Additional Notes: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: e,-2.56-i `.0 0 Public Works has no scope--- PW Not Required 6 Additional Notes: ELECTRICAL Additional Notes: f-- 6/2"//8 Approved By: Date: Approved By: Date: