620 112TH ST SE SPACE 159 2021-11-08

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# �l D' 040 Al I BUILDING PLANNING Intake OK by: V► I ' Date: i0/Z.E 119 Intake OK by: Assign To: Pr1-, Date: a/2b1� IIntake Comments: Intake Comments: r / l 1t vte 1oca+el or Dvranr . ;n hi010,1 home par- 1• Ea.Route to Commercial Building (cr - cru IL.4(..) ❑ Attach to Project No. 2. ID Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit "OK to Route to Other Departments Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer Garage 4ccessory truct.Size rl io Mt- Zone Number of Stories Overlay/Agreement Basement ®No ❑Yes, Fin/Unfin Nonresidential Use Type of Construction 'g (j Residential Use WI antfr C--virA n Occupancy Group u Proposed No.of Dwelling Units: -- Occupancy Load Total No.of Dwelling Units: Fire Sprinklers: El Update Existing ❑New System Mot Req'd Planni ndscape Inspection Required before Final? ❑Yes Reason Sprinklers Required: "In Lieu"Fee: Fire Alarm: El Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: IN Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes IN No ❑Ev chool Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: VALUATION CALCULATION: Total$ 52Oo Approved By: NS, Date: 1)_I 3// PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: IPW Worksheet Needed if: 'DSys Dev Eval ❑Traffic Mit Eval I ElSite Work or Drainage Proposed Approved By: ' Date: Ig/2/111 DBackflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, ;supportive housing) FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items Fire Dept. Fees: ❑ A Separate PW Permit is Required (Permit#: PW ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: ❑ Public Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: 67, (/Z 2 l if