4004 RUCKER AVE 2024-06-24 - Laserfiche WebLink

Intake &Approval Sheet • PP (FOR PERMIT STAFF ONLY) • PERMIT# 525(0 - 0 0 e BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement Bldg/TI/Addn/Rem Size Nonresidential Use Garage/Accessory Struct. Size Residential Use Number of Stories Proposed No. of Dwelling Units: Basement ❑No ❑Yes , Fin/Unfin Total No.of Dwelling Units: Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No Occupancy Group "In Lieu"Fee:Type: Amount$ Occupancy Load School Impact Fee: Total $ Cert. of Occpuancy Required? Wo ❑Yes ❑Shell Only Calculated: Credit: Code Year 02021 02018 02015 ❑Everett School Dist DMukilteo School Dist Fire Sprinklers: ❑Update Existing New System 1741vot Req'd Park Impact Fees for permits applied for after 1/1/2022: Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) Fire Alarm: ❑Update Existing New System Not Req'd Fee Schedule Used For Calculation(Year): Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes 11I'No Add'I RCW 64.55 docs required prior to final? ❑Yes ©No Additional Notes: VALUATION CALCULATION: Total $ � � HA.1 Approved By: Date: PUBLIC WORKS Intake OK by: Date: Intake Comments: PW Review&Worksheet Needed if: ❑Sys Dev Eval: ❑Water ❑Sewer ❑Storm Additional Notes: i 's❑Traffic Mitigation Eval 1 Approved By: (J �y Date: i 1 I�11 ,0 j❑Site Work/Drainage(shown/triggered) l i I❑Address Letter FIRE DEPARTMENT f❑Backflow Prevention for high hazard: /Deferred Submittals Required: (dental,medical,animals,mortuary, Separate !hospital,supportive housing) DFire Sprinklers DFire Alarm ❑Other: 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 fully digital ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) Approved By: Date: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) ❑ Public Works has no scope on this permit--- PW Not Required ELECTRICAL/PLUMBING Additional Notes: Additional Notes: Approved By: Date: Completed By: Date: