2002 MADISON ST EVERSPACE 2022-02-22

Intake & Approval Sheet 10 (FOR PERMIT STAFF ONLY) * PERMIT # n\ kot I 1 —O"1 10 . BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size Garage/Accessory Struct. Size Number of Stories Basement ❑No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Reason Sprinklers Required: Fire Alarm: []Update Existing ❑New System ❑Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Add'I RCW 64.55 docs required prior to final? ❑Yes ❑ No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: K) I J FIRE DEPARTMENT Separate / Deferred Submittals Required: []Fire Sprinklers ❑Fire Alarm ❑Other: Additional Notes: Fire Dept. Fees: ❑ Review of As -Built Plans - NO FIRE FEE ❑ Minimal or No Fire Scope - NO FIRE FEE ❑ Review Inspection Scope -ADD FIRE FEE Approved By: Date: ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: Assign To: Date: �I j Intake Comments: ❑ Attach to Project No. Route to Historic Reviewer OK to Route to Other Departments ❑ Hold in Planning File Drawer Zone Overlay/Agreement Nonresidential Use Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? ❑Yes No "In Lieu . Type: Amount $ School Impact Fee: Calculated: it: ❑Evere chool Dist ❑Mukilteo School Ad I final Notes: Approved By: Date: PUBLIC WORKS Intake OK by: Date: I% I � I gal .... ..... .,,,,..... ................. .......... _......... .... ............................ ...................................... Intake Comments: WIN Worksheet Needed if., 4-a-+ • o'-- ' ❑Sys Dev Eval CjTraffic Mit Eval []Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: 1Jca "raw Sc4r2< _(dental, medical, animals, mortuary, hospital, ;supportive housing) :.......................... ............................................................................,......... _....................... ....... ......... El Route this folder for PW Review at end --- PW Review Worksheet ❑This project also has a separate concurrent PW Review (Green Folder) AND ❑Create Green Folder []Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items ❑ A Separate PW Permit is Required (Permit #: PW ) AND ❑ Is located in this folder ❑ Is in a Separate Green Folder (join with this folder for permit issuance) ❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) 4-Rublic Works has no scope --- PW Not R uired Additional Notes. may' — �i 13 2c,�Gt A Approved By: Date: -�