3018 21ST ST 2022-01-21 - Laserfiche WebLink

• Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# q t.t- V b BUILDING PLANNING Intake OK by: ,,y Date: I 0 ,3I(c, Intake OK by: Assign To: Date: Intake Come : Intake Comments: -- 0 Route to Commercial Building ❑ Attach to Project No. ❑ Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit 0 OK to Route to Other Departments Bldg/Tl/Addn/Rem Size ❑ Hold in Planning File Drawer Garage/Accessory Struct;Size Zone - . Number of Stories Overlay/Agreement Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use ,,//�� Type of Construction Residential Use X, ,(, G6T-4:— Occupancy Group Proposed No.of Dwelling Units: — Occupancy Load Total No.of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes FNo Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: ❑Update Existing El New System ❑Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: 6,.0,jjor. ( p iI 0N) t.y VALUATION CALCULATION: Total$ %.1e-A Ov- Cknares* fe,iy2A,v,,Vaeryeet 0.1, foil-- d Hk, Approved By: 4, (4 Date: )0-23-1ci PUBLIC WORKS Intake OK by:—1-1-3` Date: 1012.3/Zo f S Additional Notes: Intake Comments: PW Worksheet Needed if: 1'o'')^1 1 "v.•o'+ 1-2-6—' " 'DSys Dev Eval OTraffic Mit Eval / =DSite Work or Drainage Proposed Approved By: Date: l=/2� (,I =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: 0 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: blic Works has no scope--- PW Not Required Additional Notes: , id /ZS i Zo t ck ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: