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• • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONL PERMIT# Q �`101 DO I <br /> PP � <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:(Ae 1,(e, Date: __ <br /> Intake Comments: Intake Comments: Assign To: 'le/INC-AV <br /> ❑ Route to Commercial Building ❑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 -s, 4 J?l f1 <br /> Bldg/TI/Addn/Rem Size ,638 -I.4 � El' Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone AV 1 <br /> Number of Stories i- Overlay/Agreement M 44.S a- Pt 1 .,/ <br /> Basement tONo ❑Yes , Fin/Unfin Nonresidential Use )61te,0 Ut-z.vl vvt1 <br /> Type of Construction `/?%. Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load (4;:l Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System IZINIot Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: '(•• &crA--{-'" "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System lZINot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: 4 'ZO 4-9" 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? ❑Yes yaINo Additional Notes:; -- <br /> VALUATION CALCULATION: Total$ 460) ocn <br /> Approved Date: y-/ i firl <br /> PUBLIC WORKS <br /> Intake OK by:�Fy Date: y—/. 2m <br /> Additional Notes: tfLCJ�N.ret z-`U ST OS; Inta e,.CIjomments: PW Worksheet Needed if: tat 41. <br /> T 0/4'C4l3�LY� l°Cl�l S'C'G1&.L.l(�7 h <br /> -ma srraw " ❑Sys Dev Eval ❑TrafficMit Eval E� <br /> `r , ❑Site Work or Drainage Proposed <br /> Approved By: Date: ,j a p� ht' yy��VV ❑Backflow Prevention for high hazard: <br /> f V191� (dental,medical,animals,mortuary,hospital, <br /> i/JEYk4 et Intel a 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: I -This Permit is Approved by Public Works <br /> ISee 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Q Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:,/j-v .h Date:/..q'—/2—/57 ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved � —'' -,, • Date: tZ f 1Z z,6R <br /> lZ <br />