3700 FEDERAL AVE JACKSON ELEMENTARY 2022-02-04

Intake & Approval Sheet 40 (FOR PERMIT STAFF ONL? PERMIT # B2-004-Qks-, BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Id I/Addn/Rem Size Garage/Accessory Struct. Size Number of Stories Basement o ❑Yes , Fin / Unfin Type of Construction 1/16 Occupancy Group 67' Occupancy Load t%S Fire Sprinklers: ❑Update Existing ❑New System Mot 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 Add1 RCW 64.55 docs required prior to final? ❑Yes .❑` No VALUATION CALCULATION: Total $ ZS a0 Additional Notes: Approved B Date:0 it 40 \l FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers 18FireAIamn ❑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:K. p W 0 Date: 5'J ,V,47 ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: Assign To: Date: 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" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: ❑Everett School Dist ❑Mukilteo School Dist Additional Notes: Approved By: Date: PUBLIC WORKS Intake OK by: Date: :..........._.._.........._.._...............................,..._.......................... _...... Intake Comments: WINWorksheet Needed if.• 'OSys Dev Eval ❑Traffic Mit Eval .[]Site Work or Drainage Proposed OBackflow Prevention for high hazard: ;(dental, medical, animals, mortuary, hospital, supportive housing) ...... ..................... ............. ............................ ....... ..... ..... ... _......................................... ........ .......... ❑ 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) ❑ Public Works has no scope --- PW Not Required Additional Notes: Approved By: Date: 1i