1920 100TH ST SE 2021-12-13 - Laserfiche WebLink

• Intake & Approval Sheet (FOR PERMIT STAFF ON09 BUILDING �i Intake OK by: V Date: 41 Intake Commen : ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size 2. Garage/Accessory Struct. Size Number of Stories Basement WNo ❑Yes , Fin / Unfin Type of Construction iJ I?7 Occupancy Group Occupancy Load (J Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Reason Sprinkl rs Required: Fire Alarm: 0 Update Existing ❑New System ❑Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes No Add'I RCW 64.55 docs required prior to final? ❑Yes D9No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: (Jr Le, (,q, Lei 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 gReview / Inspection Scope - ADD FIRE FEE Approved By: , 'o W Date: - S �� ELECTRICAL Additional Notes: Approved By: Date: • PERMIT# PLANNING Intake OK by: Date: Intake Comments: Assign To: ❑ 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 Mo "In Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: It: ❑Everett School Dist kilteo School Dist Additional Notes: lh��V- r aom- &iv)— l\-o C, �✓� i)`�e. its caf -2,1c� AAr,k—# Approved By: k�,J Date: PUBLIC WORKS Intake OK by: TI%A Date: to I et 12.01 4 ----- ----- - ----- I --------------------- Intake Comments: ;PW Worksheet Needed if." ❑Sys Dev Eval ❑Traffic Mit Eval ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: A004 c-BLS :(dental, medical, animals, mortuary, hospital, ;supportive housing) ------------------------------------------ D 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: