10127 21ST AVE W 2023-06-22 - Laserfiche WebLink

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1 W ?/D.0-47 " t i9 7 BUILDING PLANNING Intake OK by: Date: Intake OK by: c- Assign To: �`v \� vL g Date: Intake Comments: Intake Comments: ❑ Route to Commercial Building ❑ Attach to Project No. ❑ Route to Residential Building ❑ Route to Historic Reviewer O Make this a"W"Permit ❑ OK to Route to Other Departments Bic1 /TI/Addn/Rem Size ,IN c?0 ElHold in Planning File Drawer Garage/Accessory Struct. Size f _% Zone '( — _. Number of Stories 2- Overlay/Agreement Basement tiNo ❑Yes , Fin/Unfin Nonresidential Use Type of Construction V8 Residential Use Occupancy Group k--3 Proposed No. of Dwelling Units: CA-Q, Occupancy Load I Total No. of Dwelling Units: V Fire Sprinklers: ❑Update Existing CI 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 El New System El Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: it: 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$ //6�(-2 /0 SO x ,Iv - S 2;5"Gt 76 116 Z ;fin Approved By- Date: S 2 O'I-1 4t PUBLIC WORKS SO) tee. Intake OK by: Date: Additional Notes: Intake Comments: iPW Worksheet Needed if: ❑Sys Dev Eval ❑Traffic Mit Eval ❑Site Work or Draina e Proposed ❑Backflow Prevention fo high hazard: Approved By: ,. C., Date:cyzi—ACizi (dental,medical,animalst uary,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) El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: PA This Permit is Approved by Public Works 181 See PW Review Worksheet and associated attached items Fire Dept. Fees: ❑ A Separate PW Permit is Required (Permit#: PW Cl Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE Cl Is in a Separate Green Folder(join with this folder for permit issuance) Cl Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: ❑ Public Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: A\A Date: 10 it J 2C 740.51,.64 1,617,021