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-t2 i(-z—oS). <br /> 14 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) '�'� r�PERMIT# !( 2 - C' S c <br /> BUILDING • PLANNING <br /> Intake OK by: .i 11, Date: .110-2"-- Intake OK by: Assign To: Date: <br /> Intake Commen@. Intake Comments: <br /> 0 Route to Commercial Building 111 Attach to Project No. S i J (, L., <br /> 14 Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2( 1 S r ❑ Hold in Planning File Drawer <br /> ;GlragAccessory Struct. Size L115- SF Zone L1 <br /> Number of Stories Z Overlay/Agreement <br /> Basement EINo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use ,1,fr,, , � Y"( <br /> Occupancy Group J -( Proposed No.of Dwelling Units: <br /> Occupancy Load t -C- Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System SNot Req'd Planning/Landscape Inspection Required before Final? DYes ❑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: rjSKqo Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes ei No DEverett School Dist la.mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ®.No Additional Notes: <br /> VALUATION CALCULATION: Total$ 2-/S1 7330 <br /> 21/&5F x I3o/5F = 1'Z7c coB <br /> ►.-tt55F x 4513/SF c�20� 7 _ Approved By: '( 1T Date: i', L( <br /> 15/S <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 'PW Worksheet Needed if: <br /> ❑Sys Dev Eval DTraffic Mit Eval <br /> IOSite Work or Drainage Proposed <br /> €0Backflow Prevention for high hazard: <br /> Approved By: ��� _ Date: 3/22f Zp2Z (dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT DRoute 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 /> CI Fire Sprinklers ❑Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> • <br /> Additional Notes: J ®-This Permit is Approved by Public Works A` <br /> IgSee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: g—A Separate PW Permit is Required (Permit#: PW LZo 4-o L_3 <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND IC-Is located in this folder <br /> Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:Y-J6V01 km Date: \2 - L\ ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved Big�— Date: ¢` tic, <br />