2117 LOMBARD AVE 2019-11-06 - Laserfiche WebLink

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# &t ii COJ BUILDING PLANNING Intake OK by: ' Date: 10-10-)q Intake OK by: 'L 14— Date: 10 )0'-1c( Intake Comments: Intake Comments: Assign To: 11-- PO LD qb-- on - A vii cw etc eery ce4if;ed -` n— +tic--- 5 a,A. add it, ice_ e4 ❑ Route to Commercial Building Li Attach to Project No._ _ ❑ Route to Residential Building 0 Route to Historic Reviewer ❑Make this a"W" Permit 1AOK to Route to Other Departments Bldg/TI/Addr� em Size /S92 SL; 0 Hold in Planning File Drawer Garage/Accessory Struct. Size a' Zone ik-2— Number of Stories Z Overlay/Agreement _ Basement ❑No ,21Yes ,("y Unfin Nonresidential Use Type of Construction jelgResidential Use Ae SC-9-- Occupancy Group F Proposed No. of Dwelling Units: --- Occupancy Load Total No. of Dwelling Units: 1 Fire Sprinklers: DUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes,No Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ . _ Fire Alarm: DUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes J I No DEverett School Dist ❑Mukilteo School Dist Add!RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: \30 dA lAS.C-cy9t.041.-4- VALUATION CALCULATION: Total$ 71 6dO 61P" '4 -5 e,l - Approved By: 41Date: 1�,1 —1 UBLIC WORKS Intake OK by:'IJ Date: I0/10 0-ati Is Additional Notes: 2.0/�-` /gG / kliS c-- Intake Comments: PW Worksheet Needed if: i 4.4'rERaor+-- Wow bv,WY ❑Sys Dev Eval ❑Traffic Mit Eval ttJon1G..4 110.41 166 ❑Site Work or Drainage Proposed Approved1r Date: mo t1►I .1GE,... O¢ uSi_ ❑Backflow Prevention for high hazard: B y' � /26 (dental,medical,animals,mortuary,hospital, supportive housing) FIRE DEPARTMENT M -oute this folder for PW Review at end ---PW Review Worksheet Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This 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) 0 See PW Review Worksheet and associated attached items Fire Sprinklers: DUpdate Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) Fire Alarm: DUpdate Existing ❑New System 0 Not Req'd AND 0 Is located in this folder Chemical Sup: DUpdate Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) Additional Notes: ,,pp[[ ElWill be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: IICJsPttblic Works has no scope PW Not Required Additional Notes;, ---..........,111.E....(:..7./. /l ,.,,f / / ELECTRICAL �G+ �Y J/ 2� Zo/8 Additional Notes: Approved By: Date: Approved By: Date: