12902 19TH AVE SE GENUINE SMILE DENTISTRY 2021-02-23

• • ran t q C) (� Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ` �` \ \6 -\ CV) r.,� BUILDING PLANNING Intake OK b / /-Date: 0 /7/0( Intake OK by: Assign To: Date: Intake Comments: Intake Comments: 77,147- ,Yes VE7 T �f 54ytitrr-rr0. 4 Route to uildin ❑ Attach to Project No. ❑ Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W" Permit ❑ OK to Route to Other Departments Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer s� Garage/Accessory Struct. Size Zone C— '..._- Number of Stories Overlay/Agreement Basement El No ❑Yes , Fin/Unfin Nonresidential Use Type of Construction Residential Use Occupancy Group Proposed No. of Dwelling Units: /, Occupancy Load Total No. of Dwelling Units: Fire Sprinklers: El Update Existing El New System El 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 El Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? El Yes 0 No Additional Notes:, e a1't" ' LAC. ))A. L)t e �j -r-C, VALUATION CALCULATION: Total$ r ZOO,CO Pa- �a > �1 l6`7 o,, 0Q� Approved By: Y�; Date: q ,, 2'-L,1 I PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Needed if: ❑Sys Dev Eval ❑Traffic Mit Eval r \ inSite Work or Drainage Proposed =❑Backflow Prevention for high hazard: Approved \�___n/ Date: /// / nv 7 _(dental,medical,animals,mortuary,hospital, :supportive housing) FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet Separate I 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 ❑Deferred Additional Notes: ❑ This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items Fire Dept. Fees: ❑ A Separate PW Permit is Required(Permit#: PW ) ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder Uoin 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: ❑ Public Works has no scope--- PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: