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411° <br /> Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# Z 22-03 — 021t, <br /> BUILDING PLANNING <br /> Intake OK by: (.-'k- Date: 3/2/zeZj Intake OK by: Assign To: Date: <br /> 1 <br /> Intake Comments: Intake Comments: <br /> V- OCt; 13N x.J <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> O Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a "W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone €.--k <br /> Number of Stories Overlay/Agreement (.\;\,0k-VOK\ V ;V,, <br /> Basement ❑No ❑Yes , fin/Unfin Nonresidential Use <br /> Type of Construction P,e- Residential Use Z-F\( <br /> Occupancy Group T Proposed No. of Dwelling Units: <br /> Occupancy Load .1 f2t, Total No. of Dwelling Units: C^:Ar\ <br /> Fire Sprinklers: ❑Update Existing ❑New System 4Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "ln Lieu" Fee: Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System ONot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: dit <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes P No DEverett School Dist Mukilteo School Dist <br /> Add! RCW 64.55 docs required prior to final? Oyes EJNo Additional Notes,.- <br /> VALUATION CALCULATION: Total $ °j'Oi 000 <br /> Approve � , r' Date: ' VS at <br /> PUBLIC WORKS <br /> Intake OK by: ';`,% Date: 3I2.`..7;2_, <br /> Additional Notes: az_ �Mier7 Intake Comments: PW Worksheet Needed if: <br /> SLf�/ �� CM ett1 f rl A .4tL v O f#.4'"c&f ®Sys Dev Eval ❑Traffic Mit Eval <br /> Cam/ s Iw 4 f'v /. ❑Site Work or Drainage Proposed <br /> Approved By: /' Date: 3/?�J/�'L ❑Backflow Prevention for high hazard: <br /> pP � 3 <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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: P` This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans- NO FIRE FEE AND 0 Is located in this folder <br /> O Minimal or No Fire Scope- NO FIRE FEE 0 Is in a Separate Green Folder coin with this folder for permit issuance) <br /> O Review/ Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: , Public Works has no scope--- PW Not Required <br /> Additional Notes: � ,, <br /> ELECTRICAL AO NAAJ V`O 07y `AVA) U"),i/1G Lc (AA tAffill\P-A, <br /> Additional Notes: 6 -1/61q Oiit a>9,it'1 pnf /1 m yt i"1 OrA <br /> Approved By: Date: Approved By 7 Date:DO\ 6"t Il,D7 <br />