3927 RUCKER AVE 2ND FLOOR 2019-04-17

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# f)tC°1 15 BUILDING PLANNING Intake OK by: if Date: I/I41lf7 Intake OK by: Date: Intake Comments i Intake Comments: Assign To: ❑ Route to Commercial Building 0 Attach to Project No. ❑ Route to Residential Building 0 Route to Historic Reviewer ❑ Make this a"W" Permit 0 OK to Route to Other Departments Bldg/TI/Addy tem Siz (02-. SF 0 Hold in Planning File Drawer Garage/Accessory Struct. Size A//A Zone • G-1 PI l)0 Number of Stories a Overlay/Agreement f-4%)0 Basement ONo ❑Yes , Fin/Unfin Nonresidential Use CR ivi L. Type of Construction 16 Residential Use Occupancy Group a Proposed No.of Dwelling Units: Occupancy Load If Z__ Total No. of Dwelling Units: Fire Sprinklers: Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes FlNo Reason Sprinklers'Required: "In Lieu" Fee:Type: Amount$ Fire Alarm: Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No DEverett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: 1,n � .ik_ eta Ivc►o e VALUATION CALCULATION: Total$ 3.450°0-CO t C ('ego adywefk 4 u s ,,,,,,;\--- Approved By: K, Date: et.11+ ) PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Needed if:: ❑Sys Dev Eval ❑Traffic Mit Eval ❑Site Work or Drainage Proposed Approved By: Date / �y ,8 ❑Backflow Prevention for high hazard: �j (dental,medical,animals,mortuary,hospital, supportive housing) FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet Intake: (Needed for Townhomes,Alley load SFR,New Commercial) OThis project also has a separate concurrent PW Review(Green Folder) ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items Fire Sprinklers: Z Update Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) Fire Alarm: NUpdate Existing ❑New System 0 Not Req'd AND ❑ Is located in this folder Chemical Sup: ❑Update Existing Clew System 8 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) Additional Notes: // ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Ga! Date: (©--ib -( '<Public Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: A lit 1 ITVA/W, Y1,0 OkaAAAz 7ff vC- ) Approved By: Date: Approved By:WW1 Cia. Date j 1 ILO k -- ----(-