1424 MADRONA AVE 2023-08-08 - Laserfiche WebLink

Intake & Approval Sheet - (FOR PERMIT STAFF ONLIlq IS PERMIT # ?123M BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size Garage/Accessory Struct. Size Number of Stories 12✓ Basement 2SNo ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: Sprinklers: ❑Update Existing El New System PLOt Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing ❑New System RNot Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes &No Add'I RCW 64.55 docs required prior to final? ❑Yes &No VALUATION CALCULATION: Total $ `ZSpo Additional Notes: Approved By: Ap Date: LJ ps2GZ 3 FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers ❑Fire Alarm ❑Other: Additional Notes: Fire Dept. Fees: ❑ Review of As -Built Plans - NO FIRE FEE ❑ Minimal or No Fire Scope - NO FIRE FEE ❑ Review / Inspection Scope - ADD FIRE FEE Approved By: Date: ELECTRICAL/PLUMBING- Additional Notes: Approved By: Date: PLANNING Intake OK by: Assign To: Date: Intake Comments: Zone Overlay/Agreement Nonresidential Use Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? ❑Yes []No "In Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: []Everett School Dist ❑Mukilteo School Dist Park Impact Fees for permits applied for after 1/112022: Park Impact Fee Total $ Fee Schedule Used For Calculation (Year): Permit Technicians: Apply Credit Per EMC19.53.200 ❑ 100% Credit- Issued 1/1/2022 - 9/2/2022 ❑ 50% Credit - Issued 9/3/2022 - 6/2/2023 ❑ 0% Credit - Issued 6/3/2023 or later Additional Notes: Approved By: Date: PUBLIC WORKS Intake OK by: Date: ...............................,.,...,.....,.....,,,...,.....,.,..,..,.,,,,.,,,,..,,,.,,,, Intake Comments: !PW Worksheet Needed if. ❑Sys Dev Eval ❑Traffic Mit Eval ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: ;(dental, medical, animals, mortuary, hospital, :supportive housing) ❑ Route this folder for PW Review at end --- PW Review Worksheet ❑This project also has a separate concurrent PW Review (Green Folder) AND []Create Green Folder []Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items ❑ A Separate PW Permit is Required (Permit #: PW ) AND ❑ Is located in this folder ❑ Is in a Separate Green Folder (join with this folderfor permit issuance) ❑ Will be issued separately (Separate Green Folder, PW Issued ahead of Bldg) ❑ Public Works has no scope --- PW Not Required Additional Notes: Approved By: Date: