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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # 5 7iV <br />J� <br />BUILDING <br />��nn <br />Intake OK by: Date; L7 vV L <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />I-} I <br />Number of Stories <br />Z <br />Basement <br />NNo ❑Yes , Fin / Unfin <br />Type of Construction <br />2� <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑ Update Existing ❑New System KNotReq'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System QNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes M No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes EQNo <br />VALUATION CALCULATION: Total $ 29 , 53i-1 <br />Additional Notes: <br />Approved By: Date: 12.1C, .2d1L <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 Date: I 0 —' 1 <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: 09 Z 3 1Z <br />Intake Comme t <br />Some minor- Corr-eL, 110C S needed, bVi. no�hino� <br />pncx - <br />w►1\ sigr,ec►r}1y LA\ker J1he des► n 5o reviews <br />60rn okher- depk. OV, ko move �orwckr- <br />N Attach to Project No. G�EV►22-022 <br />❑ Route to Historic Reviewer <br />® OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />R - <br />Overlay/Agreement <br />N/A <br />Nonresidential Use <br />N iA <br />Residential Use <br />SFR <br />Proposed No. of Dwelling Units: <br />, (p� 2 <br />Total No. of Dwelling Units: <br />1 (04 1 on 10 <br />Planning/Landscape Inspection Required before Final? ❑Yes EINo <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist NMukilteo School Dist �i 2(, UCH <br />Additional Notes:NeedS bv`tdin°j he•yhr C.c%1LQ\aO"ion3 <br />24ZZ Pur14. 2, Z3. uG <br />Approved By: 3eSS►LCA Grvi Date: 3cj 2 2Z <br />PUBLIC WORKS <br />Intake OK by: __J `t Date: _..!s 3 0! = <br />...............,.......... ,.........................,......... ........._.......... _......... ... ...............,.......__.. _.. <br />Intake Comments: !PW Worksheet Needed if.• <br />S t y o L. 3 [ Dev Eva] Traffic Mit Eval <br />aSite Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />!(dental, medical, animals, mortuary, hospital, <br />supportive housing) <br />........ ................. .............................................................................................. .............. ,.. _.. ... <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 15Create Green Folder ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />0 See PW Review Worksheet and associated attached items <br />A Separate PW Permit is Required (Permit #: PW 22Dl - 02_ j ) <br />AND ❑Is located in this folder <br />y <br />F� Is in a Separate Green Folder (join with this folderfor permit issuance) <br />❑ WIII 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."_�&VWA/KJDate: <br />11 <br />