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fil <br /> cl <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 0190(0 — 03 <br /> BUILDING PLANNING <br /> Intake OK byH< ./7, Date: 06/2-rtaiy Intake OK by: {- Date: (;)-. 24:;- I <br /> Intake Comments: Intake 11Comments: e�Assi n To: . T U �C.r\ <br /> , ,e'/'t tc dnh' ,t//Ef2S rd Skkt/nYTXJ; -i Cct 0^i� ?1PA <br /> Z,,,e S'r OF ,4,44/5". - 1ncJ1r PS101CcU* la C a_A off" Ian ck(c rey. <br /> L.a r&&IL €,4LccC c,4Yr dS • /- <br /> ❑ Route to Commercial Building ES Attach to Project No. -6\ ST_\el-0)b <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer 6 \-if: N (W 4-1) <br /> ❑ Make this a"W" Permit 14 OK to Route to Other Departments Oic 1 f I /�`"I� <br /> Bldg/TI/Addn/Rem Size 23Li' -i''t a 2 n Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone U L-I <br /> Number of Stories 1 Overlay/Agreement <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction vez' Residential Use <br /> Occupancy Group 3- z Proposed No. of Dwelling Units: <br /> Occupancy Load 1Z_ Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System KJNot Req'd Planning/Landscape Inspection Required before Final? EYes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing it New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required:$°, -.4. 3 .. s t¢g Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? El No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add]RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total $ 1 P..c , la(D <br /> >{-C.0$ -r 13L ) (1 O 't' ( 5.4•5)Ll 3R-) <br /> Approved By: - Date: 1 /,j ( c7 <br /> — � �'� DSO � �3 030 1�-'`= i 6��� �� 1 <br /> PUBLIC WORKS <br /> Intake OK by: 1: ' Date: 6/ 2-13--- <br /> Additional Notes: Ems. t3i..v6} ca4 Lo'c REtuta.td Intake Comments: PW Worksheet Needed if: <br /> 14-WrANwtti-cc F-t RC peSTirre..a-t,= S1ts ft.t l Sys Dev Eval alTraffic Mit Eval <br /> ttvt Glip ._}tea, C v4Q <br /> , . 1 2OuPM. - IZSite Work or Drainage Proposed <br /> Approved By: „I Date: 125/Kt (,2,/j fZ2ot- DBackfIow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: EIThis <br /> ++�,project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other:_ AND /Ll[JCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ,This •Permit•is Approved by Public Works <br /> aSee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: A Separate PW Permit is Required (Permit#: PW 1'D?_035 ) <br /> ❑ Review of As-Built Plans- NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope- NO FIRE FEE E Is in a Separate Green Folder(join with this folder for permit issuance) <br /> IReview/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: K• b/7 4/1A. wmidatt: 11 a3I 2-611 ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: , p 6c... Date: 9174�19 __ <br /> Z•�41 <br />