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M21tZ-05, 2 t[2—c 16 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 71(2 --O.. Z_ <br /> BUILDING PLANNING <br /> Intake OK by: Yfr Date: q ,(,.4, Z Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <br /> ❑ Route to Commercial BiJilding 0 Attach to Project No. <br /> 14 Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2-1,t0 51 0 Hold in Planning File Drawer <br /> ( ccessory Struct.Size Li.(S-SF" Zone <br /> Number of Stories 2 Overlay/Agreement _ <br /> Basement '❑No DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction C- Residential Use _ <br /> Occupancy Group .ice- Proposed No.of Dwelling Units: , <br /> Occupancy Load .-(- • Total No.of Dwelling Units: _ <br /> Fire Sprinklers: ❑Update Existing ❑New System -Not 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 ENot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: 504(6 II----11 Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yeses No ❑Everett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ 215,530 <br /> Approved By: Date: , <br /> PUBLIC WORKS'. <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: iPW Worksheet Needed <br /> SDSys Dev Eval DTraffic Mit Eval <br /> I DSite Work or Drainage Proposed <br /> Approved By: V.4.... Date: 3/ZZ/zoz�2, jOBackflow 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 I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: liZL.This Permit is Approved by Public Works <br /> El-see PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: Separate PW Permit is Required(Permit#: PW 2-2--o4-u2-G ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Ats 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: <,R\-G�,,,n Date: /42 g-�/ ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By L Date: 4 ( .)Zv22 <br /> �j <br /> / <br />