4918 23RD AVE W 2021-09-02 - Laserfiche WebLink

Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 1)1°1 (0 ''1 r7 BUILDING PLANNINGl.�` Intake OK by: Date: to©h/ig Intake OK by: Assign Toil X Date: 16/((P/(Ct Intake Comments: Intake Comments: IOC ri or worn orl ly ❑ Route to Commercial Building ❑ Attach to Project No. Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit VI OK to Route to Other Departments Bldg/TI/Addn em ize 34-o g ❑ Hold in Planning File Drawer Garage/Accessory Struct. Size. Zone P.—5 Number of Stories Overlay/Agreement Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use Type of Construction `V Residential Use SF 12- Occupancy Group Proposed No.of Dwelling Units: Occupancy Load Total No.of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Panning/Landscape Inspection Required before Final? ['Yes J Reason Sprinklers Required: "In Lieu"Fee: Amount Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total Reason Fire Alarm Required: Calculated: Credl : RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ❑Eve chool Dist ❑Mukilteo School Dist Add'l RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: VALUATION CALCULATION: Total$ Z1 , O Approved By: oV .5 Date: 11 peyqPUBLIC WORKS Intake OK by: 411)'!�cJ Date: iond/7-4Z9' Additional Notes: 2_0`S / mac Intake �Comments: , �� PW Worksheet Needed if: , e GUI � WI4rk. 'DSys Dev Eval ❑Traffic Mit Eval OSite Work or Drainage Proposed Approved By: V"., Date: ii1.7/f p =DBackflow Prevention for high hazard: i(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 ❑Other: AND El 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 0 Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) - ❑ Review/Inspection Scope-ADD FIRE FEE 0 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:J Date: `Qni/ze8