2215 LOMBARD AVE 2023-06-22 - Laserfiche WebLink

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# '3 o l - 0 l 0 BUILDING 0 •LANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone Overlay/Agreement 0 Route to Commercial Building Nonresidential Use ❑ Route to Residential Building Residential Use ❑ Make this a"W" Permit Proposed No. of Dwelling Units: 'i l/Addn/Rem Size (-b3 Sr- Total No.of Dwelling Units: Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No Number of Stories t-/Jy "In Lieu" Fee: Type: Amount$ Basement IMNo DYes , Fin/Unfin School Impact Fee: Total $ Type of Construction Calculated: edit: Occupancy Group DEverett School Dist ❑Mukilteo School Dist Occupancy Load Park Impact Fees for per ' s applied for after 1/1/2022: Fire Sprinklers: ❑Update Existing El New System Not Req'd Park Impact Fee Total (net due after credit for existing uses) Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire Alarm: DUpdate Existing El New System , Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ❑Yes EgNo 0 50%Credit-Issued 9/3/2022 6/2/2023 Add'I RCW 64.55 docs required prior to final? ❑Yes EN() 0 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total $ \7-,210 Additional Notes: filL '---PfYloi<144 214422 . Approved By: Date: • PUBLIC WORKS Additional Notes: Fcxod,)b cs� Q- QA — Intake OK by: Date: s l oseEcpow„ Intake Comments: PW Worksheet Needed if:fs�Vl OSys Dev Eval(UtillsW)OTraffic Mit Eval Approved By: r 90 Date: Z /Li2v23 OSite Work/Drainage ❑Address Letter DBackflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT supportive housing) Separate I Deferred Submittals Required: ❑Route this folder for PW Review at end ---PW Review Worksheet ❑Fire Sprinklers ❑Fire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred ❑This Permit is Approved by Public Works Fire Dept.Fees: ❑ See PW Review Worksheet and associated attached items ❑ Review of As-Built Plans-NO FIRE FEE 0 A Separate PW Permit is Required(Permit#:PW ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder ❑ Review/Inspection Scope ADD FIRE FEE El Is in a Separate Green Folder Gain with this folder for permit issuance) AApproved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) ❑ Public Works has no scope---PW Not Required ELECTRICAL/PLUMBING Additional Notes: Additional Notes: Approved By: Date: �uompleted By: Date: