2930 MAPLE ST KAISER PERMANENTE 2025-05-12

Intake & Approval Sheet (FOR PERMIT STAFF ONLr PERMIT # '✓ V� / �� BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bld I/ ddn/Rem Size Soo _f Garage/Accessory Struct. Size Number of Stories Basement ❑No ❑Yes , Fin / Unfin Type of Construction �r A Occupancy Group 13 Occupancy Load Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Reason Sprinklers Required: Fire Alarm: -19Dpdate Existing El 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 $. // 000- 0 Additional Notes: Approved By , ,� Date: q FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers IRrireAlarm ❑Other: Additional Notes: Fire Dept. Fees: ❑ Review of As -Built Plans - NO FIRE FEE ❑ Minimal or No Fire Scope - NO FIRE FEE ❑ Review / In ection Scope - ADD FIRE FEE Approved By: % �-7t,- Date: e ' 7 ' . -el � ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: Date: Intake Comments: Assign To: ❑ Attach to Project No. ❑ Route to Historic Reviewer ❑ OK to Route to Other 96partments ❑ Hold in Planning File Drawer Zone Overlay/Agreement Me-� an (wre Nonresidential Use CJI L Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? ❑Yes R'No "In Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: ❑Everett School Dist ❑Mukilteo School ist Additional Notes: ) 1 j (`�_ L ��U � Approved By: Date: PUBLIC WORKS Intake OK by: Date: •----------------------------------------- Intake Comments: ;PW Worksheet Needed if. El Sys Dev Eval ❑Traffic Mit Eva] ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: :(dental, medical, animals, mortuary, hospital, supportive housing) : ----------------------------------------- DRoute 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 associated 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: