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

Intake & Approval Sheet (FOR PERMIT STAFF ONL 1) PERMIT # 51U 1 0 � 5 BUILDING Intake OK by: Alt, Date: /Ol3/Zy22 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 Basement No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: ❑Update Existing ErNew System ❑Not Req'd Reason Sprinklers Required: %GIWAV"C JeN3.1 Fire Alarm: ❑Update Existing El New System Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ER No Add'I RCW 64.55 docs required prior to final? ❑Yes NNo VALUATION CALCULATION: Total $/D I Additional Notes: Approved By: i Date: 91A1,?OZ'% FIRE DEPARTMENT Separate / Deferred Submittals Required: ire Sprinklers El Fire Alarm ❑Other: Additional Notes: Fire Dept. Fees: ❑ Review of As -Built Plans - NO FIRE FEE ❑ Minimal or No Fire Scope - NO FIRE FEE L'7 Review / Inspection Scope - ADD FIRE FEE Approved By: n Date: /�2 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 $ 30 � O Calculated: ,30/-0 Credit: O'Everett School Dist ❑Mukilteo School Dist Additional Notes:,J%j » SC J 3 Approved By: �'"�� Date: — Z3 PUBLIC WORKS Intake OK by: —A( Date: 04 — 12 _ Ai .. ................................................................................................................................_._. _.. Intake Comments: PW Worksheet Needed if., ❑Sys Dev Eval PYraffic Mit Eval []Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: j (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 MSubmitted 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 22O2,_0I D ) AND ❑ Is located in this folder Is in a Separate Green Folder Qoin 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:` 1 ��