2930 MAPLE ST KAISER PERMANENTE 2025-05-12

Intake & Approval Sheet (FOR PERMIT STAFF ONLI9 PERMIT #_� Z00 ! r0yJ BUILDING Intake OK by: Date: �l /y 0,6 2b2Z Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size Garage/Accessory Struct. Size — Number of Stories Basement []No IZYes, Fin / Unfin Type of Construction =A Occupancy Group S' 1 Occupancy Load 2 Fire Sprinklers: Update Existing El New System []Not Req'd Reason Sprinklers Required: Fire Alarm: Z Update Existing ❑New System ❑Not 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 No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: 4 -u ;0W u FIRE DEPARTMENT Separate / Deferred Submittals Required: El Fire 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: Date: ELECTRICAL 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: Credit: ❑Everett School Dist ❑Mukilteo School Dist Additional Notes: Approved By: q,I b bate: 5 PUBLIC WORKS Intake OK by: Date: LJab� Intake Comments: PIN Worksheet Needed if.• ill Sys Dev Eva] ❑Traffic Mit Eval ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: (dental, medical, animals, mortuary, hospital, supportive housing) .......................................................................................................................... ......... _. ❑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 ❑Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works ❑ See PW Review Worksheet and ass ' ted attached items A Separate PW Permit is Required (Permit #: PW ) AND ❑ Is located in this folder ❑ 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: 14a' �/z