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III <br /> Wake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) PERMIT# \9 q ' °3o <br /> J. <br /> BUILDING PLANNING <br /> , <br /> Intake OK by: Date:/// P Intake OK by: f Assign l o: s✓(e C Cl Date: i I /Z�/ <br /> Intake Comments: Intake Comments: <br /> 1-f❑ Route to Commercial Building IF. Attach to Project No. 904}1 lY 0 <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> Make this a"W"Permit C OK to Route to Other Departments <br /> Idg I/Addn/Rem Size 43`. ,57 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size 4 Zane VY\ —IV ' <br /> Number of Stories I Overlay/Agreement <br /> Basement RN() ❑Yes, Fin/Unfin Nonresidential Use Van f l, r >r- '� <br /> Type of Construction V6 Residential Use <br /> Occupancy Group ({ Proposed No.of Dwelling Units: <br /> Occupancy Load 4/q Total No.of Dwelling Units: —' _— <br /> Fire Sprinklers: ❑Update Existing ❑New System Callot Req'd Planning/Landscape Inspection Required before Final? ❑Yes L1d'No <br /> Reason Sprinklers Required: , "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System �CJ'Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ['Yes IS No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes law Additional Notes: --""--' <br /> VALUATION CALCULATION: Total$Z03 9S0 3/ <br /> Approved Date: /2. 2y /q <br /> PUBLIC WORKS J <br /> Intake OK by: Date: 11 Z - <br /> Intake Comments: _PW Worksheet N Needed it <br /> Additional Notes: <br /> I3Sys Dev Eval ?©Traffic Mit Eval <br /> OSite Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: Date: f/S 7ZO/9 <br /> f� 1 I(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: This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers El Fire Alarm ❑Other: AND ®Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 7,, lOrthis Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑ A Separate PW Permit is Required (Permit#: PW ) <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 ❑ Is 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved :,•��� Date: ,Z/, , ad1 <br /> N <br />