4808 EVERGREEN WAY THE KUSHERY 2022-06-28

Intake &Approval Sheet 41111 (FOR PERMIT STAFF ONLY) PERMIT# $2/D6 --60 BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: ❑ Route to Commercial Building ❑ Attach to Project No. ❑ Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit ❑ OK to Route to Other Departments Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer Garage/Accessory Struct. Size Zone Number of Stories Overlay/Agreement Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use roll w Type of Construction Residential Use Occupancy Group Proposed No.of Dwelling Units: Occupancy Load Total No.of Dwelling Units: Fire Sprinklers: El Update Existing ONew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes XNo Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: CI Update Existing El New System El Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 dots required prior to final? ❑Yes El No Additional Notes: of idea., on VALUATION CALCULATION: Total$ Approved By: A V Date: -7,s zi C.UBLICWOEKS ` Intake OK by: Date: Additional Notes: Intake Comments: Worksheet Needed if: i0Sys Dev Eval OTraffic Mit Eval I DSite Work or Drainage Proposed Approved By: Dater'/Z/Z� OBackflow Prevention for high hazard: i(dental,medical,animals,mortuary,hospital, :supportive housing) FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) ❑Fire Sprinklers El Fire Alarm ❑Other: AND El Create Green Folder ❑Submitted Previously El Deferred • Additional Notes: ❑This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items Fire Dept. Fees: ❑ A Separate PW Permit is Required(Permit#: PW ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: ❑ Public Works has no scope--- PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: