4522 EVERGREEN WAY STATE FARM INSURANCE 2020-02-07

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# .)ElOS -OOC K&As,:;7,--;,,,, 7141.271:1,'-::-:„,::,-,-,i*-ii-Lviwiioz,,,,. r,„,,Awipmprimszo,:aleilt,MMitti.vi,,,NsZcZ7 Intake OK by: Date: Intake OK by: (.SDate: qi ( ,/,) /�� Intake Comments: Intake Comments: Assign To: le-2 ❑ Route to Commercial Building 0 Attach to Project No. ❑ Route to Residential Building El/ Route to Historic Reviewer ❑ Make this a"W"Permit OK to Route to Other Departments Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer Garage/Accessory Struct. Size Zone e— I Number of Stories Overlay/Agreement Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use1-cQ.. Type of Construction Residential Use Occupancy Group Proposed No. of Dwelling Units: Occupancy Load Total No. of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes El No Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: El Update Existing El New System El Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo School Dist Add.'RCW 64.55 docs required prior to final? El Yes ❑No Additional Notes: VALUATION CALCULATION: Total$ Approved By: otr, Date: el- 2-(p. 11 r U b0 Intake OK by: Date: Additional Notes: Intake Comments: ipw IPwworksheet Needed if: ❑Sys Dev Eval ❑Traffic Mit Eval !Mite Work or Drainage Proposed Approved By: Date: S70..6 I I xf €❑Backflow Prevention for high hazard: ji(dental,medical,animals,mortuary,hospital, ;supportive housing) ,iii, 1 :„„, ', 1,ME IT ,-, ❑Route this folder for PW Review at end ---PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) El Fire Sprinklers El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: ylK,This Permit is Approved by Public Works 0 See PW Review Worksheet and associated attached items Fire Dept.Fees: 0 A Separate PW Permit is Required(Permit#: PW ) ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(loin with this folder for permit issuance) ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: 0 Public Works has no scope---PW Not Required Additional Notes: u i Additional Notes: '� + Approved By: Date: Approved By: cArr �-' Date: SS-/J 1,101 ok (-2-/::