9612 19TH AVE SE A 2023-12-18 - Laserfiche WebLink

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # �ZZU1 0� BUILDING Intake OK by: Date: /Ofj/Zo�L2 Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size /S"%?j $F Garage/AccessoryStruct. Size 542,1 vF Number of Stories .3 Basement &No ❑Yes , Fin / Unfin Type of Construction X-OC Occupancy Group Occupancy Load � Fire Sprinklers: ❑Update Existing I New System El Not Req'd Reason Sprinklers Required: "A46— 'Qk Vits Fire Alarm: ❑Update Existing ❑New System PQNot Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes No IIZ�11 Add'[ RCW 64.55 docs required prior to final? ❑Yes NNo VALUATION CALCULATION: Total $ 233Z 10 577 3 s x r 3d/SF 42,0111 yq b 57(01 5F- x S I B _4 28� 6 I 1 _ 2 33/ to/ Additional Notes: 5!/ to ft ptT7" L-DTS Approved By: AIL. Date: /0/3/Ze�.2.. FIRE DEPARTMENT Separate / Deferred Submittals Required: ire 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 Ea 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: ❑ Attach to Project No. ❑ Route to Historic Reviewer ❑ OK to Route to Other Departments ❑ Hold in Planning File Drawer 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 $ .3d/& _ Calculated: 3 O/0 Credit: ETEverett School Dist ❑Mukilteo School Dist Additional Notes: A-) Z HAproved By: Date: PUBLIC WORKS Intake OK by: Date: U �7 — 2 Z — ._........ ............. ........ ........ .................... _.......................................................__ _....___.•___. 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 19.13ubmitted 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 Qoin with this folder for permit issuance) ❑ WIII be Issued separately (Separate Green Folder, PW issued ahead of Bldg) ❑ Public Works has no scope --- PW Not Required Additional Notes: Approved By: Date: