1101 GRANDVIEW AVE 2025-08-07 - Laserfiche WebLink

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# a(r— 0%1, BUILDING LANNING Intake OK by: 1'23 Date: kl � 771—' Intake OK by: Assign To: Date:///Og/Z2 Intake Comments: Intake Comm Zone R-) Overlay/Agreement Co rl r.ec+or S+reef ❑ Route to Commercial Building Nonresidential Use 1J/A Route to Residential Building Residential Use S�R ❑ Make this a"W" Permit Proposed No. of Dwelling Units: Bldg/TI/Addn/Rem Size Total No. of Dwelling Units: Garage/Accessory Struct. Size, Planning/Landscape Inspection Required before Final? DYes NNo Number of Stories "In Lieu" Fee:Type: Amount$ Basement ❑No DYes , Fin/Unfin School Impact Fee: Total $ Type of Construction 34C- Calculated: Credit: Occupancy Group -t- ❑Everett School Dist ❑Mukilteo School Dist Occupancy Load ,YtC, Park Impact Fees for permits applied for after 1/1/2022: Fire Sprinklers: ❑Update Existing ❑New System KIot Req'd Park Impact Fee Total$ (net due after credit for existing uses) Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire Alarm: DUpdate Existing ONew System gNot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? DYes u�t No 0 50%Credit-Issued 9/3/2022-6/2/2023 Add'I RCW 64.55 docs required prior to final? ❑Yees I9No 0 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total $ 1.1'I1 '7,0 Additional Notes:Lt) C ppl icc&i-ior\ Covtiop‘et-ed, see >7.\--L1(1ZZ- IIA7 Approved By: > Date: It i ZZ. �ZZ PUBLIC WORKS Additional Notes:f2 at..t.„ /L L 2iti,/r Intake OK by: Date: i "' Intake Comments: PW Worksheet Needed if: J221 — 00 c 1 fit* F0,1- L01{41-10(\iS DSys Dev Eval(Util/SW) OTraffic Mit Eval Approved By: r/�j , Date: 4/f,4/�j2,? Chita Work/Drainage DAddress Letter �' DBackflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT supportive housing) Separate/Deferred Submittals Required: ❑Route this folder for PW Review at end ---PW Review Worksheet ❑Fire Sprinklers ❑Fire Alarm ❑Other:_ DThis project also has a separate concurrent PW Review(Green Folder) Additional Notes: AND DCreate Green Folder ❑Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works Fire Dept. Fees: ❑ See PW Review Worksheet and associated attached items ❑ Review of As-Built Plans-NO FIRE FEE ❑ A Separate PW Permit is Required (Permit#: PW ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ 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---PW Not Required ELECTRICAL/PLUMBING Additional Notes: Additional Notes: Approved By: Date: Completed By: Date: