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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# CNCI-0(a-o(.2 <br /> BUILDING PLANNING <br /> Intake OK by: Date: 6 1171/? Intake OK by: Date: La /i7M. <br /> Intake Comments: Intake Comments: Assign To: WA <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size :.;(75$ AHold in Planning File Drawer <br /> Garage/Accessory Struct.Size 4T.S S.P. Zone 1-- I <br /> Number of Stories 2— Overlay/Agreement <br /> Basement �No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Y � Residential Use S F 2_ <br /> Occupancy Group Proposed No.of Dwelling Units: 1 <br /> Occupancy Load Total No.of Dwelling Units: S <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? �% es ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System El Not Req'd School Impact Fee: Total $ */ ILI,2,95." <br /> Reason Fire Alarm Required: Calculated: ( SFIe X 1'I,1so Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ET No Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EtNo Additional Notes: <br /> VALUATION CALCULATION: Total $ Z 32i 63 a <br /> 11513 S F . l2 l = 2t't 1 7 L S w5(i` i4- <br /> I ( 5 5,+ 48 lci h 920 Approved By: Date: c ( 1 ct <br /> PUBLIC WORKS ` <br /> Intake OK by: Date: 4/71/ <br /> Additional Notes: 20 (5 3IZC. 4 (AJ'& L Intake Comments: PW Worksheet Needed if: <br /> 1ne 3 7' Sys Dev Eval affic Mit Eval <br /> ' � �'""71" 17 Site Work or Drainage Proposed <br /> Umr ❑Backflow Prevention for high hazard: <br /> Approved By: Date: jo/I$/1 Lj (dental,medical,animals,mortuary,hospital, <br /> ` supportive housing) <br /> FIRE DEPARTMENT laRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: This((project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm DOther: ANDJ^—kreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 2 This Permit is Approved by Public Works <br /> E See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: SA Separate PW Permit is Required (Permit#: PW 19O6—617 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope- NO FIRE FEE EtIs in a Separate Green Folder(Join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes:Approved By: Date: Approved By: (�Q <br /> � Date: 1/1iffffJ9 h 4 <br />