1009 112TH ST SE BLDG A 2022-01-19

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#' �Q tO—650 BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: ore- ,s(0 X \1' Q(14- oA RACkckeat ❑ 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 KCB do I/Addn/Rem Size 6S'9 37 0 Hold in Planning File Drawer Garage/Accessory Struct. Size ij/14 Zone `\r Number of Stories / Overlay/Agreement Basement ErNo ❑Yes , Fin/Unfin Nonresidential Use Type of Construction (/it3 Residential Use V1\IJt\\-. "" ..41"%\f Occupancy Group u Proposed No. of Dwelling Units: Occupancy Load 'I Total No.of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System Ddot Req'd Planning/Landscape Inspection Required before Final? ❑Yes INo Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: ❑Update Existing ❑New System SNot Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No DEverett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes laNo Additional Notes: VALUATION CALCULATION: Total II I . ®d Approved By:( —I Date: \a, it,sc`5:\ PUBLIC WORKS Intake OK by: tl1 Date: as/ . 12.a 19 Additional Notes: Intake Comme, s: I PW Worksheet Needed if: (.0 4$, Az-w / ❑ -cum,.A. .lo �eC�.AcGO toys Dev Eval Traffic Mit Eval c.►.R ;-4)0,-e IDi6ite Work or Drainage Proposed Approved B` �"-4/,� � v Date:/D� 2/ZOg � (� I' t 'Rst.o_ feAICuarBackflow ........P....r..e...v.. .e....n.....t..i..o.....n_....f..o_...r...h...ig....h...h....a...z....a....rd._ : (dental,medical,animals,mortuary,hospital, 'tu.L*FE4bd- 3' bV: =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 ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: '72 This Permit is Approved by Public Works li% See PW Review Worksheet and associated attached items Fire Dept. Fees: 0 A Separate PW Permit is Required(Permit#: PW ) ❑ Review of As-Built Plans-NO F FEE AND 0 Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE ' E 0 Is in a Separate Green Folder(loin with this folderforpermit issuance) O Review/Inspection Scope-ADD FIRE F - 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By:/1, - Date: /aZZ/Zetcj 0 Public Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved Date: 06 2 l i cT