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Ih take &Approval Sheet I (FOR PERMIT STAFF `I NLY 1111 PERMIT#J\C;\l\"034- <br /> i BUILDING PLANNING <br /> �:, s+ >� r ill Assign To:T�( C Cl Date: I; / z/i i <br /> Intake OK by:Cy.„'A,_ Date: /22,1 w"i f Intake OK by: 1, g <br /> Intake Comments: i Intake Comments: <br /> ❑ Route to Commercial Building Attach to Project No. <br /> 40PA IiQ •b,�4 <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ElMake this a"W"Permit ,-,-,/ <br /> OK to Route to Other Departments <br /> dg I/Addn/Rem Size /fib }'F ® Hold in Planning File Drawer <br /> garage/Accessory Struct.Size AI Zane ;t ill —Ifl <br /> Number of Stories / Overlay/Agreement <br /> Basement I No ❑Yes, Fin/Unfin Nonresidential Use Trari 5 i+6-0-Hal <br /> l <br /> Type of Construction 4/,8 Residential Use <br /> Occupancy Group a Proposed No.of Dwelling Units: <br /> Occupancy Load- u/ Total No.of Dwelling Units: —® ,� <br /> Fire Sprinklers: ❑Update Existing ONew System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes INC <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System (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 43 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes LJNo Additional Notes: ------- <br /> VALUATION CALCULATION: Total$ /7 SZ', / <br /> Approved B `---e/ Date: /Z 2q Iei <br /> PUBLIC WORKS <br /> Intake OK by: Date: 1/// - 2 <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if: <br /> =QSys Dev Eval ?DTraffic Mit Eval <br /> ®Site Work or Drainage Proposed L <br /> �, iOBackflow Prevention for high hazard: <br /> Approved Bye�,� Date: //7-7/o/�f <br /> — � / :(dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT CEIRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ®Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: his 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 ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder coin 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 B v Date: /Z ll /7 <br />