2615 BROADWAY QFC 2021-11-10 - Laserfiche WebLink

Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) • PERMIT# IZ4r0 o 65 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 0 Route to Historic Reviewer ❑ Make this a"W"Permit 0 OK to Route to Other Departments Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer Garage/Accessory Struct.Size Zone t . \ Number of Stories Overlay/Agreement Basement ❑No ❑Yes, Fin/Unfin Nonresidential\Use . cam,;\Type of Construction Residential Use Occupancy Group Proposed No.of Dwelling Units: Occupancy Load • Total No.of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ! es ❑No Reason Sprinklers Required: "In Lieu"Fee:Type: Amoun Fire Alarm: El Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Cr-: : RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mu•' eo School Dist Add'I RCW 64.55 dots required prior to final? ❑Yes ❑No Additional Notes: VALUATION CALCULATION: Total$ 672,Ob Approved By Date:VC,Q_ZOLA PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: DPW Worksheet Needed if: IDSys Dev Eval ❑Traffic Mit Eval IDSite Work or Drainage Proposed Approved B A �/ Date: lt.0� 1]Backflow 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) El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: ❑This Permit is Approved by Public Works 0 See PW Review Worksheet and associated attached items Fire Dept.Fees: 0 A Separate PW Permit is Required(Permit#: PW ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder ❑ 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: 0 Public Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: