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• • `� <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# C \ log g <br /> BUILDING PLANNING <br /> Intake OK by: -T-11-frDate: 7/I21i4' Intake OK by: (43, Date: 5 / 121/ I <br /> Intake Comments: Intake Comments: Assign To: - I C',)' <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> bg-Route to Residential Building ❑((Route to Historic Reviewer <br /> O Make this a"W" Permit RY OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2'2-(o ' 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size &37 Zone IZ- 1 <br /> Number of Stories 2 Overlay/Agreement <br /> Basement {74No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction 'IK Residential Use ' 1 1?- <br /> Occupancy Group 12,/IA Proposed No. of Dwelling Units: I <br /> Occupancy Load ot Total No. of Dwelling Units: I <br /> Fire Sprinklers: DUpdate Existing ❑New System 6N Re.9) Planning/Landscape Inspection Required before Final? Yes �9No/ <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ 4z e-i—] <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No DEverett School Dist PMukilteo School Dist <br /> Add.'RCW 64.55 docs required prior to.final? ❑Yes ri4No Additional Notes: tfeirt-snivel ' -' V i k1 , <br /> VALUATION CALCULATION: Total$ 32(4 S 3S S- + C IL Sul tit-`ir rc,9u IY e cI <br /> 22-7 c 'o 68to <br /> es-) a 1'g, Alp`lZco Approved By: �I/OS Date: )j/7 I C1 <br /> .21.0 e t2 f 2.74 S1`I PUBLIC WORKS <br /> Intake OK by: ev> Date: 7//9— <br /> Additional Notes: 20 Is- If c t w... 6G Intake Comments: PW Worksheet Needed if: <br /> w C / C� 9A>an,..-./c,1l ❑Sys Dev Eva! ( Traffic Mit Eval <br /> �2e f"d 2 ,C 1 Site Work or Drainage Proposed <br /> Date: � F li my. ❑Backflow Prevention for high hazard: <br /> Approved By: <br /> ��/�/E (dental,medical,animals,mortuary,hospital, <br /> fr^ supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: PThis project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND 11Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0.This Permit is Approved by Public Works <br /> Wiiii(0 W (rf 'f II'G ihytteutt Q See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: p A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans- NO FIRE FEE AND ❑ Is located in this folder <br /> Minimal or No Fire Scope- NO FIRE FEE 0'1s in a Separate Green Folder(join with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: VkA the ,%/ MDate, 1Z}11 1'0ICI 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL 1,�- <br /> Additional Notes: VU(7►ft(h brSO� D fi � <br /> Approved By: Date: Approved By-: / — Date: <br />