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Intake &Approval Sheet (FOR PERMIT STAFF ONL� PERMIT# \,0 0 O" <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> �_ �_�_�_m_.__ I tiG"7 I-1 �_ld Planning ra_ ram__..._ <br /> BIG(3./'I I//kddn Rem Size L�� `� LI f7V1U in rile UIdWCI <br /> Garage/Accessory Struct.Size �,,1� Zone C-1' <br /> Number of Stories ( Overlay/Agreement cc r� <br /> Basement ®No ❑Yes, Fin/Unfin Nonresidential Use 6-CRP— <br /> Type of Construction Z-/v Residential Use <br /> Occupancy Group 4 Proposed No. of Dwelling Units: <br /> Occupancy Load 75a Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System allot Req'd Planning/Landscape Inspection Required before Final? ❑Yes lNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System iNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes p No ❑Everett School Dist ❑Mukilteo Sc41 Dist Add'I RCW 64.55 docs required prior to final? ❑Yes ©No Additional Notes: pc, e...,)0Arioe-- �,CtriaiN S r2J+ AWia <br /> ltaieJ <br /> VALUATION CALCULATION: Total$ 3 77 000.06 t. - i. ffnk -- I A v-- L L ood.-- <br /> Approved By: ,> r Date: 2_- i -19 <br /> PUBLIC WORKS <br /> Intake OK by T X Date: 3 12"1 'zo/4 <br /> Additional Notes: Intake Comments: PW Worksheef Needed if: <br /> "'"lat SrcLRE Fw"J ,A'Q I�Sy Dev Eval A s Dev Eval ❑Traffic Mit Eval <br /> S-ralL.._s <br /> Site Work or Drainage Proposed <br /> ►�-CTI-Esc - 5 vcf wa`14- ❑Backflow Prevention for high hazard: <br /> Approved By: .1A--- - Date:0-4740 ni-t owr a F AIDA (dental,medical,animals,mortuary,hospital, <br /> s-w. . S ... Zoo SF <br /> supportive housing) <br /> FIRE DEPARTMENT Route 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 N tes: ,� This Permit is Approved by Public Works <br /> Ut1 sA'(!1 1-IR�S7e,f1'A kle./-,4 re ❑ See PW Review Worksheet and associated attached items�(� SeparatePW Permit is Required (Permit#: PW <br /> Fire Dept. Fees: � ❑A q ) <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(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.. . JdoW`(\ Date:--L-I q ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B . ate: 6/17 /Zo / q <br />