5901 23RD DR W PROVIDENCE 2023-05-22

<aa Intake &Approval Sheet �(FOR PERMIT STAFF ONLY) • PERMIT# 0 e--009, 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 ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: CI Update Existing ONew 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 DEverett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 does 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: iDSys Dev Eval ❑Traffic Mit Eval • • ❑Site Work or Drainage Proposed Approved By: Date: DBackflow 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 I 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 ❑Deferred Additional Notes: ; ❑This Permit is Approved by Public Works ❑See PW Review Worksheet and associated attached items Fire Dept. Fees: 0 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 0 Is in a Separate Green Folder(loin 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: A Date: g--1--,2 ❑ Public Works has no scope---PW Not Required Additional Notes: I r4 w` ELECTRICAL . gy el Gl Izav Additional Notes: Approved By: Date: Approved By' k Mokyt Date: 45 1 0 2,67/2/