2231 LOMBARD AVE 2025-01-10 - Laserfiche WebLink

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: 3e.SS Date: Co/5/Z.J-4 Intake Comments: Intake Comme ts: Zone R'Z ❑ Make this a"W" Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement 5icl<e 'c 1 k rtcr•;; Bldc1ddn em ize - • f Nonresidential Use `— Garage/Accessory Struct. Size U/PC Residential Use S F tZ. Number of Stories 2 Proposed No. of Dwelling Units: 0 Basement 'lo Oyes , Fin/Unfin Total No. of Dwelling Units: Type of Construction i R.C. Planning/Landscape Inspection Required before Final? ❑Yes JNo Occupancy Group I e.G. "In Lieu" Fee:Type: Amount$0 Occupancy Load IRS School Impact Fee: Total $0 Cert. of Occpuancy Required? Er No ❑Yes ❑Shell Only Calculated: Credit: Code Year 1E12021 02018 02015 ❑Everett School Dist ❑Mukilteo School Dist Fire Sprinklers: DUpdate Existing ❑New System ErNot Req'd Park Impact Fees for permits applied for after 1/1/2022: Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) Fire Alarm: ❑Update Existing ❑New System Mot Req'd Fee Schedule Used For Calculation(Year): 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 No Additional Notes: VALUATION CALCULATION: Total $ gib GOO Approved By: Date:(o/5 Jzy PUBLIC WORKS Intake OK by: Date: Intake Comments: PW Review&Worksheet Needed if: 3❑Sys Dev Eval Additional Notes: DWater ❑Sewer ❑Storm {NT&RtOk D -0 MIAA IOTraffic Mitigation Eval Approved By: •A Off--_ Date:/qt Jv►4 A.Q5 I❑Site Work/Drainage(shown/triggered) I❑Address Letter FIRE DEPARTMENT 10Backflow Prevention for high hazard: Separate/Deferred Submittals Required: (dental, medical,animals, mortuary, q =hospital,supportive housing) DFire Sprinklers ❑Fire Alarm ❑Other: Additional Notes: ❑ This Permit is Approved by Public Works 0 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: AL_,��UY( Date: 0 cj/J j(J19z