10121 EVERGREEN WAY JIMMY PEPPERS 2023-04-06

• •Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# W\(q� O —C.) - . BUILDING . !I.A NING , , , Intake OK by: Date: Intake OK by: Date: Intake Comments: Intake Comments. Assign To: ❑ 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 / !tit Jd Number of Stories Overlay/Agreement Basement ❑No DYes , Fin/Unfin Nonresidential Use L CJ l/({rf 1C(U Type of Construction Residential Use i Occupancy Group Proposed No. of Dwelling Units: -Occupancy Load Total No. of Dwelling Units: ; _ Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes , No Reason Sprinklers Required: "In Lieu" Fee: Type'�� -amount$ Fire Alarm: ❑Update Existing ❑New System ❑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.'ROW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: VALUATION CALCULATION: Total $ k', JoJ r16:-(e,rVulf/t-4- i)Kif 1 S IMNUeI -t4Gi✓I Cxlshl1j_ ,7Gra pet J Approved By: _,(,1-;-; Date: .e1 /2 p// 1 PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: IPW Worksheet Needed if: ❑Sys Dev Eval Traffic Mit Eval ❑Site Work or Drainage Proposed Approved By: Date: t)) tG? _❑Backflow Prevention for high hazard: _(dental,medical,animals,mortuary,hospital, :supportive housing) FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑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 0 Is located in this folder 0 Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection Scope-ADD FIRE FEE 0 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: