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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# rJ2.200 t OS <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: 4 Intake OK by: Assign To: Date: <br /> Intake Comments: 1��� Intake Comments: <br /> • <br /> Route to Commercial Building El 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 /> BldgfTl/Addn/Rem Size gS Coc) 44-a ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone L5- Z <br /> Number of Stories 1 Overlay/Agreement <br /> Basement INo ❑Yes, Fin/Unfin Nonresidential Use /id-DLLSP et — <br /> Type of Construction 111 — 15> Residential Use <br /> Occupancy Group ` ► �� 1. Proposed No.of Dwelling Units: / <br /> Occupancy Load — Total No.of Dwelling Units: / <br /> Fire Sprinklers: ❑Update Existing ®New System ONot Req'd Planning/Landscape Inspection Required before Final?/{VYes ❑No <br /> Reason Sprinklers Required: > &C O'44 "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing®New System ❑Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: ' 4 2 Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes ElNo Additional Notes: e_ ?Nate!,-Fe£_. <br /> VALUATION CALCULATION: Total$ G014+2-35.2-0 <br /> q-dl,e, 4 .1to5) •A j 1*tex p r (� <br /> Approved By: Date: !®' <br /> j BOi 2 4t•F x 0.,3 ' '`Z2_ <br /> n Gat 4423*-I.a PUBLIC WORKS <br /> Intake OK by: . Date: I <br /> Additional Notes x Intake Comments: _PW Worksheet Needed if: <br /> t el.d.. Gp ti t vT �Tlc 4 ONLY <br /> DSys Dev Eval OTraffic Mit Eval <br /> §DSite Work or Drainage Proposed <br /> Approved By: � Date: 10/r4/2y 2L )_IBackflow Prevention for high hazard: <br /> • =(dental,medical,animals,mortuary,hospital, <br /> supportive housing) <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 /> Viftre Sprinklers Fire Alarm El Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ELThis Permit is Approved by Public Works <br /> rrES.See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: Iit-A Separate PW Permit is Required(Permit#:PW (t 12-o z4 ) <br /> ❑Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> 0 Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> eview/Inspection Scope-ADD FIRE FEE lawill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:' -y 'o(,U.n Date:5_4 0 22 ❑ Public Works has no scope—PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B t — Date: 4(1:7 ('Zoyi <br />