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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ev 16105 — o <br /> 14 <br /> BUILDING PLANNING Intake OK by: <Ift7 Date: 517 7 I/7 Intake OK by C E Date: S- 2-0 <br /> 0)q <br /> ` <br /> Intake Comments: Intake Comments: Assign To: a `3- °l A <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> aRoute to Residential Building ❑ Route to Historic Reviewer <br /> 0 Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size Y 3 20 SF- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone ' - <br /> Number of Stories I Overlay/Agreement / <br /> Basement , No ❑Yes , Fin/Unfin Nonresidential Use C nn <br /> Type of Construction �C3 Residential Use 5` \\ <br /> Occupancy Group Proposed No. of Dwelling Units: C k,Q ( \ <br /> Occupancy Load Total No. of Dwelling Units: ,_ ( t <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ONot Req'd School Impact Fee: Total $ c,CC) C Ze-cc, <br /> r, <br /> Reason Fire Alarm Required: Calculated: \I,2- -0-L' Credit: * OM_ -' <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes lgj No ®Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EINo Additional Notes: <br /> VALUATION CALCULATION: Total $ /62/85S <br /> 132-0 @ l 21 = /s S 1zo <br /> ^ <br /> lad-S 30 3 3� Approved By: —�( ) Date: 5-C , Z-U\9 <br /> PUBLIC WORKS <br /> Intake OK by: Date: Si 712011 <br /> Additional Notes: Zp15 /4C 47 Ct>SEC Intake Comments:" /. PW Worksheet Needed if:• <br /> i2u,5 , ei Hit uMl' slitSys Dev Eval ❑Traffic Mit Eval <br /> /� t(NC Sys dE� W• SW(4' Site Work or Drainage Proposed <br /> ppBy: A6 LP I l-1 I l' I w f�, l��r 1 C2 - ❑Backflow Prevention for high hazard: <br /> Approved )l�/tpate: et <br /> paAJ lege 4_. 8- (dental,medical,animals,mortuary,hospital, <br /> "I� n "' supportive housing) <br /> �/s DEV <br /> FIRE DEPARTMENT Route 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 /> ❑Fire Sprinklers DFire Alarm ❑Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 'IkA Separate PW Permit is Required (Permit#: PW 161 O5-00-1 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ars in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ 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: <br /> Approved By: Date: Approved By: "14../ Date: eto 9-�it�bp& <br />