3102 ROCKEFELLER AVE CANFIELD MADOW LAW GROUP 2022-11-28

ci Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# j(41061'''0Z 0 BUILDING PLANNING Intake OK b Date: 0 /V 7 Intake OK by: Assign To: Date: Intake Com tents. Intake Comments: F�v\ ,n b q se,w�n� ,-t Ace i.re q3.c t�:an \ �qs\�t� ❑ Route to Commercial Building ® Attach to Project No. U J E ?s "1 —Q 0 ❑ Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit ❑ OK to Route to Other Departments Bldg/TI/Add em Size 3` t.? CI Hold in Planning File Drawer Garage/Accessory Struct.Size ,4/r4 Zone U M Number of Stories Z.- Overlay/AgreementJSs-te€\ 02s \ `Li Basement ❑No laYes , in Unfin Nonresidential Use d.. ck Type of Construction SQ Residential Use Occupancy Group Proposed No.of Dwelling Units: Occupancy Load Z 6' Total No.of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System C1Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes No Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: ❑Update Existing ❑New System Shot 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 dots required prior to final? ❑Yes 8 No Additional Notes: VALUATION CALCULATION: Total$ ZSb Oho �XAse IA.Q)A\ S ,�A Aug WVA ( Qt' S\ei ,-- ' .Q.\\ tea\ \Ie ukuAt a% o s C --4'Approved By: Date: q ,\ON. t_Q `CN PUBLIC WORKS Intake OK by:'I—ti\ Date: 9 /1 W / i `t Additional Notes: Intake Comments: PW Worksheet Needed if: - a.nlTcct•o tz i c/l' 12-Ckj1=iA;rw Sys Dev Eval ❑Traffic Mit Eval i ,- 10 ' M A,c. !a'c.4i Ns. a Site Work or Drainage Proposed Approved B Date: /07y/ � -- A-o-0 -tz.,,,,,,yea ,��rY I OBackflow Prevention for high hazard: :(dental,medical,animals,mortuary,hospital, To 'I5v+.�n..,L.� vCI�,µ.-r, _supportive housing) FIRE DEPARTMENT VRntlte 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 ❑Submitted Previously ODeferred Additional Notes: " 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(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,32,,,y1 Date: `2—/—if ❑ Public Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By Date: // /Z Jf 9