12800 19TH AVE SE 2022-07-14 - Laserfiche WebLink

• 4110 Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Z I OS —003 BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: ❑ Route to Commercial Building ❑Attach to Project No. ❑ Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit ❑ OK to Route to Other Departments Bldg/TI/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 Occupancy Group Proposed No. of Dwelling Units: Occupancy Load Total No:of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System Mot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: CI Update Existing ❑New System CI Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ['Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: VALUATION CALCULATION: Total$ Approved By: Date: PUBLIC WORKS'` Intake OK by: Date: Additional Notes: Intake Comments: 'PW Worksheet Needed if: =DSys Dev Eval ❑Traffic Mit Eval • DSite Work or Drainage Proposed Approved By: Date: ;OBackflow Prevention for high hazard: i(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) CI Fire Sprinklers ❑Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: This Permit is Approved by Public Works 'j 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 Sc pe-ADD FIRE FEE ` ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: �—�c) Date: 7/ /VI ❑ Public Works has no scope--- PW Not Required Additional Notes: -77M A'k4-14-A 4 Pre ELECTRICAL € (LSI 2.624 Additional Notes: Approved By: Date: Approved B . Date: 060hoZ i