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• <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# '22-1)7' 'o 3 <br /> BUILDING PLANNING' � • .•. . . . <br /> • <br /> Intake OK by: (LV--' Date: V 10G2104 Intake OK by \ Assign To: Date: 247/77_— <br /> Intake Comments: Intake Comments: <br /> I J c4'1 ei66111,6V <br />- ❑ Route to Commercial Building ❑Attach to Project No. <br /> lEtRoute to Residential Building < r 0 Route to Historic Reviewer <br /> '��m.ki fh' "W Pe—!i4 _ 0 OK to Route to Other Departments <br /> BIdg/Tl/ jeiRem Size L O Se - ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone 12\—l <br /> Number of Stories 2 Overlay/Agreement <br /> Basement ❑No Saxes,6/Unfin Nonresidential Use . <br /> Type of Construction . l// Residential Use j '12.... <br /> Occupancy Group '��/, Proposed No.of Dwelling Units: . <br /> Occupancy Load f Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System iiil 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 gNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? Dyes nl®No Additional Notes: <br /> ] <br /> VALUATION CALCULATION: Total$ `000 y <br /> J .P,&, ( 4�-s-h 1/L /zz <br /> Approved B0 j.Q yar4 Y,I Date: 2/ 1 /77 <br /> PUBLIC VIIORKS'' <br /> Intake OK by: Date: <br /> Intake Comments: iPW Worksheet Neede• if: <br /> Additional Notes: i <br /> iDSys Dev Eval F Traffic'Mit Eval <br /> OSite Work or►'.inage Proposed <br /> Approved By: (sL Date: M572/327..— I OBackflow' evention for high hazard: <br /> =(dental,mei al,animals,mortuary,hospital, <br /> isupportiv ousing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at en ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate c. current PW Review(Green Folder) <br /> El Fire Sprinklers OFire Alarm ❑Other: AND ❑Create Green Folder ❑" bmitted Previously ['Deferred <br /> Additional Notes: ; 0 This Permit is Approved by'ublic Works <br /> 0 See PW Review Works -et and associated attached items <br /> Fire Dept.Fees: 0 A Separate PW Per is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located i- this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a S-parate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will b issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public We ks has no scope---PW Not Required <br /> Additional ►•otes: <br /> $(. <br /> ELECTRICAL <br /> Additional Notes: ' <br /> Approved By: Date: Approved By: Date: <br /> i <br />