3211 BROADWAY AMERICAN INSURE ALL 2020-01-21

vIntake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# S lat Qt- 0 On BUILDING PLANNING Intake OK by: Date: Intake OK by: Date: Intake Comments: Intake Comments: Assign To: c3 O \q9.. . S\%\ s su c .&, owst.,errs ss ` 0 c,\ s ,Size , s ,c ❑ 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/Tl/A.ddn/Rem Size 0 Hold in Planning File Drawer Garage/Accessory Struct.Size Zone . Number of Stories Overlay/Agreement `.J Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use Ices\QA Type of Construction Residential Use Occupancy Group Proposed No.of Dwelling Units: Occupancy Load Total No. of Dwelling Units: Fire Sprinklers: ❑Update Existing Chew System ❑Not Req'd Planning/Landscape Inspection Requ'--d before Final? ❑Yes ®No Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ Fire Alarm: ❑Update Existing Chew 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: Pv .Q,CCATQA i'eQeQ VALUATION CALCULATION: Total $ /� 6S .00 r 'J\C \S ,� 9.o -w,A•5- Approved By: C-� Date: ` NC I PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Needed if: ❑Sys Dev Eval ❑Traffic Mit Eval Mite Work or Drainage Proposed Approved B ' �t.,,l Date: O��jc� ❑Backflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, supportive housing) FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) ❑Fire Sprinklers ❑Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously El Deferred Additional Notes: 0 This Permit is Approved by Public Works 0 See PW Review Worksheet and associated attached items Fire Dept. Fees: 0 A Separate PW Permit is Required(Permit#: PW ) O Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: RI 'ublic Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: