11108 EVERGREEN WAY ALEM MARKET 2022-11-17

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# oil l 07— 00 pp BUILDING �Q PLANNING Intake OK by: 7 Date: .1 Intake OK by:A. Assign Toll L 4 Date: .?/b/1A Intake Comments: Intake Comments: • El Route to Commercial Building 0 Attach to Project No. ❑ Route to Residential Building ❑ R ute to Historic Reviewer ❑ Make this a"W"Permit OK to Route to Other Departments Bldg/TI/Addn/Rem Size \€' S 4--kA Hold in Planning File Drawer Garage/Accessory Struct.Size — Zone 1411 t. Number of Stories i Overlay/Agreement Basement giNo ❑Yes, Fin/Unfin Nonresidential Use (rci . Type of Construction V- '�j _ Residential Use U Occupancy Group M Proposed No.of Dwelling Units: ____ Occupancy Load :..t.v _ Total No.of Dwelling Units: Fire Sprinklers:A Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No Reason Sprinklers Required: tP W-tasr "In Lieu"Fee:Type: Amount$ Fire Alarm: MI Update Existing ❑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 ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes 1,21No Additional Notes: Na ex-f crcor vv#1K- for VALUATION CALCULATION: Total$ cJb,dx, of feaV',(AA S ear ,4• Approved By: //e Date: gllivA • PUBLIC WORKS Intake OK by: . Date: Additional Notes: Intake Comments: PW Worksheet Needed if: I OSys Dev Eval OTraffic Mit Eval IDSite Work or Drainage Proposed Approved By: X/gf . Date: /( lZ 44 =�Backflow Prevention for high hazard: I 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) ❑Fire Sprinklers `Fire Alarm ❑Other: AND ❑Create Green Folder OSubmitted Previously ❑Deferred Additional Notes: 0 This Permit is Approved by Public Works ❑ 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 coin with this folder for permit issuance) VS-Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By:\,S u1/4J j1 Date: S`2IA az\ Public Works has no scope---PW Not Required Additional Notes: L t e ELECTRICAL 4`4UL D >✓-1 d/wv, ►o i l I'167 &YYt'd do Additional Notes: .7 NO[ ra- Approved By: Date: Approved By: t v4Az Datetef2i1t� • /Z