1528 GRAND AVE 2022-04-01 - Laserfiche WebLink

• Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# �D9'--4.1' BUILDING PLANNING 1 IL �°I Intake OK by: Date: � /l q Intake OK by: Date: (/61/I el Intake Comments: Intake Comments: Assign To: -01 e Y\ 0166117 can ro. ciNeviait f a tA I aree.fN`k-✓t-i- ❑ Route to Commercial Building ❑ Attach to Project No. ® Route to Residential Building 11:p *cute to Historic Reviewer ❑ Make this a"W" Permit V: OK to Route to Other Departments I Bldg/TI 'de•tap Size OG / L3 �F ❑ Hold in Planning File Drawer Garage/Accessory Struct. Size ('73 SF Zone 12- -2- t-lL Number of Stories Overlay/Agreement V,,c:'p(Ci ic& { c 'iC Basement ❑No DYes , Fin/Unfin Nonresidential Use Type of Construction Residential Use ,SF)Z Occupancy Group P, (,i(, Proposed No. of Dwelling Units: Occupancy Load 04 Total No. of Dwelling Units: Fire Sprinklers: ❑Update Existing DNew System PrVot Req'd Planning/Landscape Inspection Required before Final? DYes 9fN0 Reason Sprinklers Required: �f "In Lieu" Fee: Type:_ Amount$ Fire Alarm: ❑Update Existing ❑New System IalNot Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? oyes allo DEverett School Dist DMukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes .No Additional Notes: Pr�B VALUATION CALCULATION: Total $ 2137t'1 25 tt-io'S r r L. f'Q_V i "2.tt) 1�' Approved By: os_,t'L,`S--r.0 (4—+ate: (TN /i } i PUBLIC WORKS ( ( I Intake OK by: —'-,. Date: q .I ft I : ci Additional Notes: 2 p / S" /R e It GU Sic.. Intake Comments: PW Worksheet Needed if: o€„.4 ST 2- Ef?• ❑Sys Dev Eval ❑Traffic Mit Eval ..k ilk / E-- - a ti' i C°-a-? ❑Site Work or Drainage Proposed Approved By: Date: N jq�j a �'"��0 �'Z,,'�z if ❑Backflow Prevention for high hazard: !I I I-1 4L (dental,medical,animals,mortuary,hospital, supportive housing) FIRE DEPARTMENT L"hRoute this folder for PW Review at end ---PW Review Worksheet Separate/Deferred Submittals Requir ❑This project also has a separate concurrent PW Review(Green Folder) ❑Fire Sprinklers ❑Fire Alarm Other: AND ❑Create Green Folder ❑Submitted Previously DDeferred / Additional Notes: / XThis Permit is Approved by Public Works g-See PW Review Worksheet and associated attached items Fire Dept. Fees: / Separate PW Permit is Required (Permit#: PW 2L)c.2•DU 8 ) ❑ Review of As-B it{Plans- NO FIRE FEE AND VS-1-8located in this folder ElMinimal or N Fire Scope NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) ❑ Review/ spection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approve By: Date: ❑ Public Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: _ Approved By: Date: Approved Date: