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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) III PERMIT# 2002 -03S <br /> BUILDING PLANNING <br /> Intake OK b . Date:�Z/Z/7Z Z a Intake OK by: Y- Assign To: - i- <br /> Date: 2- -Z1'Z020 <br /> Intake Comments. Intake Comments:- <br /> 0� (. ,0Na-- 1t2_- L - p&a,-\- <br /> - 6 A190 c - 'AC-c" uk Q Co - (4^44 <br /> WiA\ 1y fe p el , "" — '5 IS <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> Bld /TI ddn/Rem Size 4,O/O MF Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size 4/41 Zone U\ <br /> Number of Stories / Overlay/Agreement ce: i - ‘D\'+-2tA - <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use 0-QM <br /> Type of Construction I/88 Residential Use <br /> Occupancy Group ` Z— Proposed No.of Dwelling Units: <br /> Occupancy Load 70 Total No.of Dwelling Units: <br /> Fire Sprinklers:,',%t pdate Existing RNew SystemMot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing,New System ❑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 ❑Everett School Dist ❑Mukilteo Scho ist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes iRNo Additional Notes: i n\ _ Ua , ()A - �� <br /> ) <br /> VALUATION CALCULATION: Total$ Z-S 000, 00 tik6�� i I �(• <br /> t _�1J <br /> Approved By: k✓- Date: (Ey. .- �� Z <br /> P LIC WORKS <br /> Intake OK by: �,5 Date: ,b Z - <br /> Additional Notes: Ptt,#lD4) O/eC/iaz., Intake Comments: =PWWorksheet Neededif. <br /> ,r� `IDSys Dev Eval Traffic Mit Eval <br /> (, $ ❑Site Work or Drainage Proposed <br /> Approved By: Date: Z� y,'ze e_.�J b OBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT IRoute 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 ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works 3 <br /> (( ❑ See PW Review Worksheet and associated attached items <br /> � �� � ��� 5'1�em Y1e e�e� <br /> Firel�Dept. Fees: ❑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 �j�� 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: -<,f Aif Date:c, aa�2d 1,5 Public Works has nos ope---PW Not Required <br /> ..- . 7..<::, Additional Note 2/2. /2a*-41 <br /> ELECTRICAL <br /> Additional Notes: 1 c o1L'9 a'L.t. 'a� -711."..-1 <br /> Approved By: Date: Approved By: Date: <br />