3 MADISON ST 2022-03-23 - Laserfiche WebLink

• Intake & Approval Sheet (FOR PERMIT STAFF ONLI9 • PERMIT # V1 I ` OZI] 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 ❑New System ❑Not Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing ❑New System El Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No VALUATION CALCULATION: Total Additional Notes: Approved FIRE DEPARTMENT Separate / Deferred Submittals Required: El 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: Date: ELECTRICAL Additional Notes: Approved By: Date: PLANNING: Intake OK by: Assign To:Date:% Intake Comments: ❑ 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 HJ l 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: Approved By:AP Date: % 2O oa-1/l PUBLIC WQRKS Intake OK by: Date: ..................................,,,,,,...........................,....,,.,,...,,,..,,.....,...,,.,,,.,.,.,............................................. Intake Comments: ;PIN Worksheet Needed if: [3Sys Dev Eva ❑Traffic Mit Eva] ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: ;(dental, medical, animals, mortuary, hospital, :supportive housing) ...... ........... .............. ........ ........... .... ElRoute 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 Qoin with this folder for permit issuance) ❑ WIII be Issued separately (Separate Green Folder, PW issued ahead of Bldg) ❑ Public Works has no scope --- PW Not Required Additional Notes: Approved By: Date: