1011 TEMPLE DR 2022-01-13 - Laserfiche WebLink

• Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Z�0Z OZ� BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: ❑ Route to Commercial Building 0 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 Number of Stories Overlay/Agreement Basement ❑No es , Fin/Unfin Nonresidential Use Type of Construction Residential Use Occupancy Group Proposed No. of Dwelling Units: Occupancy Load Total No. of Dwelling Units: Fire Sprinklers: ❑Up to Existing ❑New System El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No Reason Sprinkler equired: "In Lieu" Fee: Type: Amount$ Fire Alarm: Update Existing El New System El Not Req'd School Impact Fee: Total $ Reason Ire Alarm Required: Calculated: Credit: RCW-64.55 MF worksheet req'd for permit? ❑Yes i�al No ❑Everett School Dist 0 Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes L3No Additional Notes: VALUATION CALCULATION: Total $ `(7 ?/O Approved By: / Date: /7-; PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: PWWorksheet.......eededif..................................................... eet Needed if.• c-C-J Like/q-/ R p 'I/ OSys Dev Eval OTraffic Mit Eval OSite Work or Drainage Proposed Approved B : {�t'/ / 'OBackflow Prevention for high hazard: pp y /�� Date: / ;(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) DFire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously El Deferred Additional Notes: 0 This Permit is Approved by Public Works 0 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 ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ 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: G Date: `''J /