11724 23RD DR SE 2021-09-02 - Laserfiche WebLink

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT#0_ACA(.0 —Ccrq BUILDING PLANNING � Intake OK by: /' Date: f cy `t Vi Intake OK by: Assign To:�'CQ,�( Date:10/i 1/1 / '1 Intake Comme ts• Intake Comments: ❑ Route to Commercial Building ❑ Attach to Project No. Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W" Permit 4DOi1/4/ 6 OK to Route to Other Departments Bldg/TI' de r i Size -S. Z. S",/ (2o SF. a Hold in Planning File Drawer Garage/Accessory Struct. Size Zone 12--• Number of Stories ( Overlay/Agreement Basement RN() ❑Yes , Fin/Unfin Nonresidential Use — Type of Construction '37 $ Residential Use FHA-fr m Iy I(-Di l'i e Occupancy Group P. Proposed No.of Dwelling Units: -- Occupancy Load Total No. of Dwelling Units: Fire Sprinklers: ❑Update Existing ONew System ENot Req'd Planning/Landscape Inspection Required before Final? ❑Yes MNo Reason Sprinklers Required: "In Lieu" e mount$ 111 Fire Alarm: ❑Update Existing ❑New System al Not Req'd School Impact Fee: Tota Reason Fire Alarm Required: Calculated: Credl . RCW 64.55 MF worksheet req'd for permit? ❑Yes la No 1:1 ".5_yor chool Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes ISINo Additional Notes: VALUATION CALCULATION: Total$ 451 g((, Ssz. sF. a 73 g0I2.% (2-0 S, 7 i &Sra Approved By: aI 1 Date: III I( 4 , PUBLIC WORKS Intake OK by: �i 't Date: £0 I I.t 1 1 R Additional Notes: 2,O/s' /Cc, GVS Intake Comments: i PW Worksheet Needed if. .�C-o,aV Earr l ��O ,r:LtsA G= €1]Sys Dev Eval ❑Traffic Mit Eval (= L .+-s6, S?,4� 1EISite Work or Drainage Proposed ,4b Approved By: Date:612.1/2_0 Flo F ycotz.a fL S �� 10Backflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, �.10/.L :supportive housing) FIRE DEPARTMENT El 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: ❑This Permit is Approved by Public Works ❑ 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 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 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: blic Works has no scope---PW Not Required Additional No • /st /(9 ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: