12503 17TH AVE SE 2021-12-13 - Laserfiche WebLink

Intake & Approval Sheet 0 (FOR PERMIT STAFF ONL 0 PERMIT # 2 t 0-7 - o 2-9 BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/Tl/ ddn em Size 8p Garage/Accessory Struct. Size Number of Stories Basement ❑No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: ❑Update Existing El New System ❑Not Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing El New System ❑Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Addl RCW 64.55 docs required prior to final? ❑Yes ❑ No VALUATION CALCULATION: Total $ tDLV"1, Additional Notes: Approved By: YJ Date: 6-7-I e,J i 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 IM Intake OK by Assign To: A. Date: -7 1-3 � Intake Comments: ❑ Attach to Project No. ❑ ute to Historic Reviewer 9OK to Route to Other Departments Hold in Planning File Drawer Zone Overlay/Agreement Nonresidential Use Residential Use cS'. 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: 2jZ PUBLIC WORKS Intake OK by:: Date: ....... _..... ......... .,._,.,..,....,._......... .... .___............................ _........... _,. Intake Comments: i PIN Worksheet Needed if: 0Sys Dev Eva[ ❑Traffic Mit Eva] I]Site Work or Drainage Proposed (]Backflow 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 M PW ) AND ❑ Is located in this folder ❑ is in a Separate Green Folder Qoin with this folder for permit issuance) ,,��jj ❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) lr'ublic Works has no scope --- PW Not Required Additional Notes: 77, o?! Iq (202.1 Approved By: Date: