10012 4TH AVE W 225 2021-11-08 - Laserfiche WebLink

Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT# j`u 2�,O3 6 BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: ❑ Route to Commercial Building ❑ Attach to Project No. ❑ Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit ❑ OK to Route to Other Departments Bldg/TI/Addn/Rem Size / Uy2I7— 0 Hold in Planning File Drawer Garage/Accessory Struct.Size — Zone Number of Stories a` t``J Overlay/Agreement Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use Type of Construction V—3 Residential Use _ Occupancy Group /C—02 Proposed No.of Dwelling Units: Occupancy Load h/d4 Total No.of Dwelling Units: Fire Sprinklers: CI Update Existing CI New System Mot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: CI Update Existing ❑New System Jot Req'd School Impact Fee: Total $ Reason Fire Alarm Required: (A 4z. T E S$1I) i? JZ Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? EYes ❑ No ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes 'No Additional Notes: VALUATION CALCULATION: Total $ CSOdO rem AL.. -g bins.-Fsx(e.or 4-s' �*' Approved By: Date: e 1 co I(' 1? Z PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Needed if: 1❑Sys Dev Eval ❑Tra;-i it Eval I❑Site Work or Drain a Proposed Approved By: Date: :VA./ /2/ 1❑Backflow Pr� t of n for high hazard: L / / i(dental,medic..;animals,mortuary,hospital, GGG ;supportive sing) FIRE DEPARTMENT DRoute this folder for PW Review at en, -PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate c/•current PW Review(Green Folder) ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder D/bmitted Previously ❑Deferred Additional Notes: -.1'IAaG,4 0.fe. Ol1Grclim- or^-- ❑ This Permit is Approved b Aublic Works M.Is 4IrtI�+*, r V� AS frA. Te rs CI See PW Review Work//�et and associated attached items Fire Dept. Fees: 1 ❑ A Separate PW Pei-rift is Required(Permit#: PW ) ❑ Review of As-Built Plans-NO FIRE FEE AND ElIs locateyn this folder Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a.'.eparate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection Sc e-ADD FIRE FEE ElWil;le issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: ,6 ,t,, Date: ?3/1(/Z1 Public 'corks has no scope PW Not Required / A dition. Notes: LECTRICAL 50/ �0 Sa pi - A t� iwkbti C t Additional Notes: , Approved By: Date: Approved By: Date: