1427 100TH ST SW 110 2021-12-13 - Laserfiche WebLink

Intake & Approval Sheet 0 (FOR PERMIT STAFF ON09 9 PERMIT # 6/1 ( �w BUILDING Intake OK by: Date: 2 �- Intake Comments: ❑ Route to Commercial Building 10 Route to Residential Building ❑ Make this a "W" Permit 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 El Not Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing ❑New System El 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 ❑No VALUATION CALCULATION: Total $ 0 Additional Notes: Approved By: Date: Z&Z_o FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers ❑Fire Alarm ❑Other: .r 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 Intake OK by: Assign To: Date: Intake Comments: S 09f olE- CC vns c S N ❑ Attach to Project No. ❑ Route to Historic Reviewer ❑ OK to Route to Other Departments ❑ Hold in Planning File Drawer Zone -3 Overlay/Agreement Nonresidential Use Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? []Yes FNo "In Lieu" Fee: Type: Amount School Impact Fee: Total $ Calculated: Cr t: ❑Everett School Dist ❑Muk1 o School Dist Additional Notes: ,ro,n� � +Y- Ivy Ne— k&v-e- LA Approved By: Date: l -7 Z- L P BLIC WORKS Intake OK by: 6 la Date: IZ 2 2019 Intake Comments: PIN Worksheet Needed if. r�A 04 H b #Ae ' ❑Sys Dev Eval ❑Traffic Mit Eval []Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: S 3 ' (dental, medical, animals, mortuary, hospital, '4 E.QS jsupportive housing) 4*4- .............................................. ........ „.............................. _........ ........................................ ....... .,,..... ❑ 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 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: PZ 12 20 19