905 MADISON ST MADISON PUB 2019-11-06

Intake & Approval Sheet (FOR PERMIT STAFF ONL19 PERMIT# I r ,V10(p-cv ` BUILDING PLANNING Intake OK by:L.A. Date: 007/z ' `f Intake OK by: Date: Intake Comments: Intake Comments: Assign To: —i' /1Dk et 70 P.01. ❑ Route to Commercial Building 0 Attach to Project No. ❑ Route to Residential Building 0 Route to Historic Reviewer ❑Make this a"W"Permit 0 OK to Route to Other Departments Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer Garage/Accessory Struct. Size Zone -1 M o 0 Number of Stories Overlay/Agreement t"-AJO Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use c ..c-/ et./"-- Type of Construction Residential Use Occupancy Group Proposed No. of Dwelling Units: Occupancy Load Total No. of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: ❑Update 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 , 0 No ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: i� �c71 feat- C( focc1'/ VALUATION CALCULATION: Total$ 3gODo,00 (er°4"1 ) �,\CIS� vn 0007�1 I ceq J t cJ `DCO29.41t Approved By: ‘1\..\•NDat . -- 7- 14 PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Needed if: ❑Sys Dev Eval DTI-• Mit Eval a ❑Site Work or Dr-' -ge Proposed ❑Backflow P - e ls for high hazard: Approved By�� f Date�6 (dental,me.' al,animals,mortuary,hospital, supporti housing) FIRE;,DEPARTMENT DRoute this folder for PW Review at d ---PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate oncurrent PW Review(Green Folder) ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder VA Submitted Previously ❑Deferred Additional Notes: 0 This Permit is Approve. •y Public Works 0 See PW Review W. ksheet and associated attached items Fire Dept. Fees: 0 A Separate PW "ermit is Required (Permit#: PW ) ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is lo -ted in this folder Minimal or No Fire Scope-NO FIRE FEE 0 Is. a Separate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection cope-ADD FIRE FEE INill be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: (., k Date: ej/Z/1 0 P •lic Works has no scope---PW Not Required Additional Notes: ELECTRICAL A ` Additional Notes: Approved By: Date: Approved By: Date: