5103 S 4TH AVE 2024-02-16 - Laserfiche WebLink

Intake & Approval Sheet •(FOR PERMIT STAFF ONLY) • PERMIT# gZ I®5--03,� BUILDING • PLANNING . . . Intake OK by: Date: Intake OK by: Assign To: Date: , Intake Comments: Intake Comments: a ❑ Route to Commercial Building ❑Attach to Project No. ❑ Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit ❑ OK to Route to Other Departments Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer Garage/Accessory Struct. Size Zone V.ri, Number of Stories Overlay/Agreement Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use Type of Construction • ZC Residential Use ( y Occupancy Group e2C Proposed No.of Dwelling Units: " . Occupancy Load Total No.of Dwelling Units: Z Fire Sprinklers: ❑Update Existing ONew System 121Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes%1No Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: El Update Existing El New System ESI Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 dots required prior to final? ❑Yes No Additional Notes: \42.rl- Laill., On VALUATION CALCULATION: Total$ ;°MOO Approved By: V_, Date: 42,c, 7,) PUBLIC WORKS- Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Needed if. S.ri 0gSLciW.4rt:,DA/ 1 EAo2S i2�I® (DSys Dev Eval ❑Traffic Mit Eval `b CoM De f �/?,I✓►'I'Ak E/ €❑Site Work or Drainage Proposed. Date: /®f917,671 1 C'Backflow Prevention for high hazard: Approved By _(dental,medical,animals,mortuary,hospital, ;supportive housing) - FIRE DEPARTMENT El Route this folder for PW Review at end ---PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) ❑Fire Sprinklers El Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: .; ❑This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items Fire Dept. Fees: ❑ A Separate PW Permit is Required (Permit#: PW ) ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) Approved By: Date: ❑ Public Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: