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0 <br />I Approval She FOR PERMIT STAFF ONL 0 PERMIT # �2,wL-0,5�, <br />Intake & Appro a Sheet ( � <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TIA gem Size <br />41!!5,2 4+4' <br />Garage/Accessory Struct. Size <br />Number of Stories <br />2.. <br />Basement <br />❑ No ®Yes 4DUnfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System gNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: []Update Existing ❑New System 5ONot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes IM No <br />Add] RCW 64.55 docs required prior to final? ❑Yes MNo <br />VALUATION CALCULATION: Total $ 1A.Z2 Gm> <br />Additional Notes: <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers []Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />64 f f ee-'n (a -dC4t-l-- Z. 3 . 2_22 . <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />V, 2. <br />Overlay/Agreement <br />e-%c,"lip r +o7wc <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved By: <br />Date: 3 3O loo2,z <br />PUBLIC WORKS <br />Intake OK by:. Date: <br />Intake Comments: �...-.....-..._......_............-..._....,.-.__-....,...-.._-.........._........._.._... <br />jPW Worksheet Needed if: <br />❑Sys Dev Eval []Traffic Mit Eval <br />❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />supportive housing) <br />[]Route this folder for PW Review at end �--- PW Review Worksheet .. - <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND []Create Green Folder ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folder for permit issuance) <br />❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved By: Date: .L <br />vI <br />