1915 CALIFORNIA ST BOTHELL FOODS 2022-01-25

Intake & Approval Sheet (V (FOR PERMIT STAFF ONLY) 0 PERMIT # S IAO3 — UDS BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ 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 El New System []Not Req'd Reason Sprinklers Required: Fire Alarm: []Update Existing ❑New System ❑Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Add'I RCW 64.55 does required prior to final? Oyes ❑ No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: -% FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers []FireAlarm ❑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: Date: ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: Assign To: Date: Intake Comments: l SST � ❑ Attach to Project No. ❑ Route to Historic Reviewer ❑ OK to Route to Other Departments ❑ Hold in Planning File Drawer Zone Qwegayftreementls:�,tka�� Nonresidential Use Q6 Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before al? ❑Yes ❑No "In Lieu" Fee: Type: A unt $ School Impact Fee: Total $ Calculated: Cr?dit: ❑Everett School Dist ❑Mukilteo School Dist Additional Notes: Approved B Date: PUBLIC WORKS " Intake OK by: Date: ............................... ................ ........................................... ......... ............... ......................... .,....,........ Intake Comments: PIN Worksheet Needed if. `Sys Dev Eval ❑Traffic Mit Eval =Site Work or Drainage Proposed �Backflow Prevention for high hazard: ,(dental, medical, animals, mortuary, hospital, ,supportive housing) i.................................................................................................................................................-. ❑ 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 (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: Z L.