1802 75TH ST SW VERIZON ANTENNA 2021-12-30

Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT # 10 b l '6 ql) BUILDING Intake OK by: Date: Intake Commen ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit I 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'l RCW 64.55 docs required prior to final? ❑Yes ❑No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: Cp F IRE DEPARTMENT Separate / Deferred Submittals Required: El Fire Sprinklers ❑Fire Alarm ❑Other: Additional Notes: Fire Dept. Fees: ❑ Review of As -Built Plans - NO F FEE ❑ Minimal or No Fire Scope O FIRE FEE ElReview/ Inspection ope - ADD FIRE FEE Approved By: Z Date: ELECTRICAL Additional Notes: Approved By: Date: PLANNING 11_ Intake OK by: �'iT Date: o Intake Comments: Assign To: Oq{ J �0 co�ng.n, POE ❑ Attach to Project No. ❑ Route to Historic Reviewer q OK to Route to Other Departments — old in Planning File Drawer Zone Overlay/Agreement Nonresidential Use l,J, `% �vLc' 11 Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? ❑Yes 1)7No "In Lieu" Fee: Type: Amount School Impact Fee: Total $ Calculated: Credit. ❑Everett School Dist ❑Mukilteo Sch of Dist Additional Notes: . T_ G04yia," bi`4j�') (to G i ti �npaQ� Vi Approved By: Date: 7. PUBLIC WORKS Intake OK by:- ITS Date: to [-Z to ISb 19 ----------------------------------------- Intake Comments: ;PWWorksheet Needed if. • ❑Sys Dev E al ❑Traffic Mit Eval 9LiF4S-t 5 ►waa,�tc� �p►� ; I to Work or Drainage Proposed ❑Backflow Prevention for high hazard: (dental, medical, animals, mortuary, hospital, :supportive housing) ---------------------------------- -- ddw oute 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 Qoin 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: