2118 JEFFERSON PL 2024-10-25 - Laserfiche WebLink

Intake &Approval Sheet I (FOR PERMIT STAFF ONLY) • PERMIT# 67,3o7 0 3 BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone / I ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement Bldg/TI/Addn/Rem Size IJ 1\ Nonresidential Use Garage/Accessory Struct.Size Residential Use , Number of Stories ` Proposed No.of Dwelling Units: Basement giNo ❑Yes, Fin I Unfin Total No.of Dwelling Units: Type of Construction 110 C 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? [,No ❑Yes ❑Shell Only Calculated: Credit: Code Year 02021 2018 012015 ❑Everett School Dist ❑Mukilteo School Dist Fire Sprinklers: ❑Update Existing ONew System 11.Not 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 El New System ❑'Not Req'd Fee Schedule Used For Calculation(Year): Reason Fire Alarm Required: /w �� RCW 64.55 MF worksheet req'd for permit? ❑ J Yes No UL '`J Add]RCW 64.55 docs required prior to final? ❑Yes INo Additionall_ y otes: VALUATION CALCULATION: Total$ ' .Q t9 ( 0410 ,�,� c/L.[ /22 � Approved By: Date: PUBLIC WORKS Intake OK by: Date: Intake Comments: PW Review&Worksheet Needed if: ['Sys Dev Eval: Additional Notes: OWater OSewer ❑Storm I❑Traffic Mitigation Eval Approved By: f ik��_ A, Date: q C ` 11,03 Mite Work/Drainage(shown/triggered) l � ['Address Letter FIRE DEPARTMENT J❑Backflow Prevention for high hazard ' dental,medical, Separate/Deferred Submittals Required: animals,mortuary, housing) supportive housing) ❑Fire Sprinklers ❑Fire 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: