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0 0 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# a2263'a39) <br /> p <br /> BUILDING , PLANNING <br /> Intake OK by: i� Date:3/116102--- Intake OK by: Assign To: &. sue.,. Dater:Lin- <br /> Intake Comments: Intake Comments: <br /> 1rArAe- C aii t l6 1 r' <br /> C�(1)e,/ �p e C� / 5))2 f1 an. 4- <br /> ❑ Route to Commercial Building ❑ Attach to Project No. 1,L <br /> El Route to Residential Building El Route to Historic Reviewer J <br /> ❑ Make this a"W"Permit K to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size s-q_( 44:- Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone it' <br /> Number of Stories '- Overlay/Agreement <br /> Basement El No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction (R C- Residential Use 8.0604 G i . <br /> Occupancy Group l Et G Proposed No.of Dwelling Units: <br /> Occupancy Load l l?G Total No.of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing ❑New System 1ZINot Req'd Planning/Landscape Inspection Required before Final? ❑Yes?No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System tgl 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 ® No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes I2iNo Additional Notes: <br /> VALUATION CALCULATION: Total$ '-4 2-. 0 <br /> 0 <br /> IR-I 4+2- if, t 1:7 <br /> Approved By: tAct Date: �j.it).22_- <br /> UBLIC WORKS <br /> Intake OK by: + ' Date: <br /> Additional Notes: U Intake Comments: =PW Worksheet Needed if.._....,..,...-_- � <br /> =DSys Dev Eval ❑Traffic Mit Eval <br /> -Sl 1 Z NO :Site Work or Drainage Proposed <br /> Approved By: Q � Date:rj �Backflow Prevention for high hazard: <br /> �` "'" ;(dental,medical,animals,mortuary,hospital, <br /> III ;supportive housing) <br /> I. <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/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 ODeferred <br /> Additional Notes: E This Permit is Approved by Public Works <br /> JaSee PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 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(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: .cn rj,n Date:3 i-2,€2, ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: 4 ,,, � �' Date: O y_ 21_20 Z7,- <br /> Z .._ <br />