1718 PINE ST 2022-04-05 - Laserfiche WebLink

Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# 2 I o4 b(.Q 1 BUILDING 11�{ PLANNING Intake OK by: Date: Intake OK by:6 t Assign To: 4 0 LC', P• Date:42-60.2a� Intake Comments: Intake Comments: ❑ Route to Commercial Building In Attach to Project No. e-V IZ I-63o ❑ Route to Residential Building 0 Route to Historic Reviewer ❑ Make this a"W"Permit OK to Route to Other Departments Bldg/TI/Addn/Rem Size 3l1O i ❑ Hold in Planning File Drawer Garage/Accessory Struct. Size al Zone Number of Stories I Overlay/Agreement Basement 'No ❑Yes , Fin/Unfin Nonresidential Use Type of Construction -e Residential Use ,S i— -I- 14llU Occupancy Group �2 Proposed No. of Dwelling Units: I Occupancy Load ✓`�— Total No.of Dwelling Units: 2- Fire Sprinklers: ❑Update Existing ❑New System LBNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes viNo Reason Sprinklers Required: "In Lieu"Fee: Type: Amount$ Fire Alarm: El Update Existing ❑New System In-Not Req'd School Impact Fee: Total $ a---'p Reason Fire Alarm Required: Calculated: edit: RCW 64.55 MF worksheet req'd for permit? ❑Yes ill;No ❑Everett School Dist Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes allo Additional Notes: VALUATION CALCULATION: Total $ CL)I(,S 0 is l ct.,r 3,) a !� 6 O Approved By: Date: �., 2 CYZ- � �I PUBLIC WORKS /t,.-,,?(, +E_.L 7 /1O 4- Intake OK by: Date: Additional Notes: Intake Comments: 3PW Worksheet Needed if: IOSys Dev Eval ❑Traffic Mit Eval i OSite Work or Drainage Proposed Approved By: (./` Dates ��/�/ OBackflow 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 DOther: AND-/ ❑Create Green Folder OSubmitted Previously ❑Deferred Additional Notes: VT_ his Permit is Approved by Public Works L_ ee PW Review Worksheet and associated attached items Fire Dept. Fees: A Sep rate PW Permit is Required (Permit#: PW24 CV�-097) ❑ Review of As-Built Plans-NO FIRE FEE AND Is located in this folder gMinimal 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:Y,,))c (,t2'\ Date:1-13..iG/ 0 Public Works has no scope--- PW Not Required Additional Notes: ELECTRICAL Additional Notes: ' Approved By: Date: Approved By: Date: 7 lit)j/ 4... )