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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ON09 <br />• <br />PERMIT# C-1g04"014 <br />BUILDING <br />Intake OK by: Date: 7% q <br />Intake Comments: <br />❑ Route.to Commercial Building <br />Route to Residential Building <br />❑ Make this a "W" Permit <br />dg I/Add em ize <br />Zfv� Zo s <br />Garage/Accessory Struct. Size <br />Number of Stories <br />2 <br />Basement <br />rrt�r <br />❑No L Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing El New System El Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System El Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ONo <br />VALUATION CALCULATION: Total $224-, Z'?CO <br />C?-os s-WMot>r,_c-. <br />Additional Notes: <br />Approved By: Date: 'Z z / I <br />FIRE :DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope -ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />l <br />Intake OK by: Date:t9 <br />_ _l <br />Intake Comments: To:� <br />(r'�� `Assign <br />AV <br />�D 9�.s <br />❑ Attach to Project No. <br />Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />CJ <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes R o <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved B Date: <br />" PUBLIC WORKS <br />Intake OK by:774_ Date: `F 7Z 1 9 <br />.------------ ----- -------------------- <br />Intake Comments: A-0v smK,+,b .a(,{PW Worksheet Needed if.• <br />A16 � C TO '?Bn.A�-j S ra <br />�. k� DU xet Z_,vo tea. Y ; ❑Sys Dev Eval ❑Traffic Mit Eval <br />:a EX�S NowA� []Site Work or Drainage Proposed 06 <br />Nto t,EV,,-��y�❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />��� ;supportive housing) <br />^- 3 7m 5t= NEw tzcyor r4+� ----------------------------------------- <br />Reute this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously []Deferred <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br />❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved Date: 7 / J' f„Q /9 <br />