12906 19TH AVE SE IN N OUT PHO 2023-06-13

• P,/i5%ort Mkr aSsu ¢.4 Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT# g2-16 8 -06 9 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 (2 , Number of Stories Overlay/Agreement Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use . Type of Construction - Residential Use r Occupancy Group Proposed No.of Dwelling Units: / _ Occupancy Load Total No.of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required efore Final? ❑Yes �No 1 Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: El 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 ❑ No ❑Everett School Dist ukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: VALUATION CALCULATION: Total$ Approved By: It. . - 4 Date: r Z, ,(0.Z , -UBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Needed If: . ❑Sys Dev Eval ❑Traffic'Mit Eval ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: Approved B ' Date:p�v yy�7 (dental,medical,animals,mortuary,hospital, �� ` supportive housing) FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) 'tire Sprinklers 9Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: .i • El This Permit is Approved by Public Works • Y..-?e,c,cy ti4 4cc \\ood ❑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 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 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By:K.9)00(.o n Date: 1,2-7-a/ ❑ Public Works has no scope--- PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: