9632 19TH AVE SE A 2023-12-22 - Laserfiche WebLink

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # b7iID C6 ,' ! —1 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 �L%yLf Sf Garage/Accessory Struct. Size $� Number of Stories ?l Basement [�No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: El Update Existing RNew System []Not Req'd Reason Sprinklers Required: fAW116146 JAC Fire Alarm: ❑Update Existing ❑New System 0Not 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 IgNo VALUATION CALCULATION: Total $ VS� OOS- itILILf rF x0 r3c /s F -='4i87, V-o 53S s x SOF- 2 lS,Do5S- Additional Notes: P(_A.f-f-VD L,p1-5 Approved By: ,� Date: & ?_&Z2 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 Review / Inspection Scope - ADD FIRE FEE Approved By: K. 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 $ Calculated: 3c .1 t- Credit: UlEverett School Dist ❑Mukilteo School Dist Additional Notes: � 4'. � 4t Approved By: , �,. Date: �; Z PUBLIC WORKS Intake OK by: Date: 2 ............... ................................................ ........................ ............................. .._............._._. _.. Intake Comments: PW Worksheet Needed if. PSys Dev Eval RTraffic Mit Eval I❑Site Work or Drainage Proposed { ❑Backflow Prevention for high hazard: !(dental, medical, animals, mortuary, hospital, ;supportive housing) ................................................ ......................... ................................................... ........... .... _...... _.. El 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 USubmitted 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 11 Is located in this folder 10 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: