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• <br /> Intake & Approval Sheet � (FOR PERMIT STAFF ONLY) PERMIT# �1�0 "b`'l7 <br /> PP l <br /> BUILDING PLANNING <br /> Intake OK by: Date: 8/�fi9 Intake OK by:(T Date: • 20 • 2-CAR <br /> Intake Comments: Intake Comments: Assign To: QQ\\oIA <br /> ❑ Route to Commercial Building ❑ 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 /> Bldg/TI/ •• ap.ize g68 5,K,/Z0(6.4.16 ❑ Hold in Planning File Drawer <br /> 't ara Accessory Struct. Size 1/3Z Zone t <br /> Number of Stories I Overlay/Agreement � \ <br /> Basement °1No Dyes , Fin/Unfin Nonresidential Use <br /> Type of Construction "TL.S' Residential Use AUQ\�X. <br /> Q./I Occupancy Group A Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: j. <br /> Fire Sprinklers: DUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes l!glNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: DUpdate 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 I�No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes Et Additional Not s: S.,\NC `MOS S jLC�� U r <br /> VALUATION CALCULATION: Total Z6O1 (1& . Cspgr \c�CiQ� �� Ste` v''-'o&N S <br /> Ij <br /> I13Z s @ �$ c-A\cOac\ \4\1%i <-e cc. cA-Qc . <br /> 565 S,P M �?1 Approved By: J Date: J-26• �c;k9 <br /> ZO((0 S,1'. Ga 56 PUBLIC WORKS <br /> Intake OK by: '-"1 Date: EL - . y <br /> Additional Notes: ZO fs IQ L. 4 (j11s-f_L Intake Comments: PW Worksheet Needed if: <br /> IS .lw a r.I <br /> 5 t-CC i4 ys Dev vl ❑Traffic QM it Eval <br /> `Site Work or Drainage Proposed <br /> 6-PptL14AwR-ri..sz- <br /> `11i i -J ,A ❑Backflow Prevention for high hazard: <br /> Approved By:Q.Walh�( I AKC Date:Ol 12,411011 Q.+(-y.oa w,�+-Q.<- <br /> t g S Ja���� (dental,medical,animals,mortuary,hospital, <br /> l--A'T1-el.,- supportive housing) <br /> FIRE DEPARTMENT tt.. Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: hThis 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: El This Permit is Approved by Public Works <br /> 5 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: SA Separate PW Permit is Required (Permit#: PW .q10- 014 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND as 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: < t c- L ,.() Date: /0—Li`l q ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By- f(1 -/- Date: /p !ft.. 1 1`? i� <br /> (27 <br />