1218 59TH PL SW 2021-12-20 - Laserfiche WebLink

Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT 4W?x5_ 0__)__q BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/T Rem Size rr Garage/Accessory Struct.. Size Number of Stories Basement 54No ❑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 El New System ❑Not Req'd Reason Fire Alarm Required: �7I RCW 64.55 MF worksheet req'd for permit? ❑Yes RNo Add1 RCW 64.55 docs required prior to final? ❑Yes EgNo VALUATION CALCULATION: Total $ ZTQ4�D Additional Notes: 2 Q/S 112-6. �_ lvShe Approved By: Date: ,—La A 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 ❑ Review / Inspection Scope -ADD FIRE FEE Approved By: A Date: J ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: Assign To: Date: Intake Comments: se ,ate JaQ ❑ 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 []No "In Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: ❑Everett School Dist ❑Mukilteo School Dist Additional Notes: &00 �vair�bo Date: v PUBLIC WORKS Intake OK by: Date: w.,-.......... ....... ,,.,...... -............. .w.,.-...... . ........ __......,.,.,,,,,..,,,;........................ ..... - Intake Comments: PW Worksheet Needed if; ❑Sys Dev Eval OTraffic Mit Eval ❑Site Work or Drainage Proposed ? ❑Backflow Prevention for high hazard: ,(dental, medical, animals, mortuary, hospital, ;supportive housing) ..........................._....... ... ...................... . �.... Y............ ............................ ... .... ................ El Route this folder for PW Review at end --- PW Review Worksheef ❑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: 06 k)